NELFT officers will give details of the Trust’s Street Triage service covering Outer North East London.
Minutes:
The NELFT officers explained that the service began following the signing, in 2014, of a crisis care concordat with the Police, social services and the London Ambulance Service. The Department of health had then funded some pilot schemes whereby local NHS services could work in partnership with the Police. This was felt necessary as dealing with mental health had been found to take up as much as 20% of Police time. The Police Federation had also raised concerns of the use of section 136 of the Mental Health Act which allowed the Police to detain people exhibiting mental health problems. It was also hoped to reduce the numbers of people presenting at A & E with mental health issues.
A street triage pilot had therefore been introduced in the acute care pathway in April 2015 and this was now operated jointly by NELFT, the Police and the London Ambulance Service (LAS). A dedicated phoneline had been set up, manned from 1700 to 0100 Monday – Friday. The service was funded by the local Clinical Commissioning Groups and allowed three band 6 mental health nurses to cover the four ONEL boroughs.
Key outcomes for the service included reducing unnecessary section 136 detentions, taking up less Police time, bringing down the amount of inappropriate use of A & E as a place of safety and the lowering of costs to the Police, NELFT and the relevant Local Authorities.
Face to face assessments were carried out as well as 7-day follow-ups of identified street triage cases. Clinical and management supervision was in place and feedback on the service was sought from service users and carers. Positive feedback had also been received from the Police. Indeed the Police had asked for the service to be extended to a 24:7 basis.
The introduction of the street triage service had seen better information sharing with GPs and the London Ambulance Service. There had also been improved engagement with service users who found the service less traumatising than previous processes. Challenges for the street triage service included the large geographical area covered, the ageing and transient population of the area and that some parties remained unaware of the pilot.
A case study was detailed where a person suffering from schizophrenia had fallen accidentally at home and had been able to be treated by the service at home, thus preventing hospital admission. Some 76% of users of the street triage service were already known to NELFT.
Street triage staff would travel to wherever an incident had occurred in order to carry out an assessment. This could be at a Police station if necessary. The team was based at Goodmayes Hospital and was able to respond within 30 minutes of a call being received. Around 2 calls were received each shift on average but this varied.
The service was open at the times the Police had indicated were their busiest (Tuesday – Friday nights) but this was being reviewed and it was possible a daytime shift could be piloted. NELFT staff were not as yet based in Police call centres due to the amount of red tape involved in arranging this.
Follow ups would be carried out with the service that people were referred on to. The NELFT Home Treatment Team would look to work with service users following their assessment by Street Triage. Overall data on the effectiveness of the service could be shared with Healthwatch etc.
Waltham Forest was the busiest borough for street triage, followed by Redbridge, Barking & Dagenham and Havering. Street triage worked closely with the social care emergency duty team in each borough. Commissioners had now agreed that funding for the service in 2016/17 should be included in NELFT’s baseline contract. This represented a commitment going forward and meant that the street triage service no longer needed to be considered as a pilot.
It was confirmed that A & E staff and the Police did notify the street triage service if a person presented with suspected mental health issues. Some staff in both organisations however, remained unaware of the service. Officers felt therefore that awareness of the service was important in order to avoid use of section 136 as much as possible and to reduce the number of presentations of mental health issues in A & E. If Members could help raise awareness of the service, NELFT officers felt that this would be of great assistance.
It was noted that NELFT was the only Trust in London that had seen a reduction in the use of section 136 across its area. While the use of the service could result in lower hospital attendances, it was unlikely that any financial gain to the service would be derived from the Hospitals Trust as A & E was not felt to be the appropriate place to assist people with mental health issues. Any increase in funding would therefore have to come from the CCGs.
It was clarified that the phone number for the street triage service was only for use by the Police or Ambulance Service. A representative from Healthwatch Havering asked for NELFT to meet with his organisation to discuss the street triage service.
NELFT officers would provide details of the street triage service as regards number of cases dealt with, response times and potential cost savings.
It was AGREED that the clerk to the committee should draft a letter to the four local CCGs asking them to confirm that the street triage service would be made permanent.