North West London’s Crisis Care Concordat Crisis Care Summit Dr Beverley McDonald, GP Mental Health Lead Hammersmith and Dr Cornelius Kelly, Consultant Psychiatrist & Medical Director, Central and North West London NHS Foundation Trust 25 February 2016

2 The journey in North West London - What is Like Minded? Like Minded is the North West London strategy for mental health and wellbeing It is co-produced with service users, carers, health and care professionals, third sector and user-led organisations and other experts. People will be able to say: My wellbeing and happiness is valued and I am supported to stay well and thrive As soon as I am struggling, appropriate and timely help is available The care and support I receive is joined-up, sensitive to my own needs, my personal beliefs, and delivered at the place that’s right for me and the people that matter to me What will Like Minded mean for people? One in four people will have a mental illness at some point in their life. In many areas people still don’t get the help they need. Like Minded aims to solve problems including… Half of all mental health needs in adults – appear before the age of 14. People with mental health needs on average die earlier.

3 Crisis Care Concordat – a critical step on our transformation journey 1 st place to sign up in London 25 North West London agencies committed 2 nd place to sign up in UK In 2014 our Crisis Care Concordat describes how organisations in Northwest London will work better together to provide urgent assessment and care where and when people need it across: Eight boroughs Twenty-five Northwest London Agencies Two million people Including 32,000 with serious mental illness Challenges developing our strategic plans: -The breadth of stakeholders across 8 boroughs (and London wide) -The lead in time to delivering change – nearly 18 months on we are really seeing on the ground change -Where to start? Prioritise across the whole system and pathway -Capacity. The same people are involved in change at borough level and centrally

4 Crisis Care Concordat – local change – an added impetus to work underway Establishing the ‘Making a Difference Alliance’ supported by NSUN who act as a nominated group of advisors representing each borough across NWL Series of Innovation Labs and events to understand patient and carer issues when a mental health crisis is experienced Advanced Diploma training in Mental Health with 36 GPs across all 8 NWL CCGs Harrow MIND are providing a multi agency training programme in Mental Health Awareness with training content localised for each CCG. New Urgent Care and Assessment pathways Implementation of a Single Point of Access to adult mental health services across CCG areas to provide a central point for referrals and assessment; Extension of operational hours in home crisis/urgent assessment and initial crisis resolution service, operating 24 hours per day, 7 days per week, 365 days per year; Achievement of agreed performance trajectories for crisis/emergency, urgent and routine. Early Intervention in Psychosis - Set of outcome measures developed through stakeholder workshops to support the agreed care pathway. EIP project accepted as a test site for Patient Knows Best (PKB)

5 Focus in detail - Urgent Care and Assessment pathway Key learnings Invest in partnership and process – it’s all about people. Know your champions for change. Data and evidence should underpin the decision-making, but it’s people who make changes. Co-Production is essential. Co-Design is easy, Co-Delivery more of a challenge. Plan and map the whole pathway in one – vital to see the sum of the parts to learn more. The best-handled crisis episode is a prevented one! Believe in the agency of people with mental health issues. Invest in self-management, resilience and staying well services. Change is a process not an event. New model 1. If you say it is a crisis we treat it as a crisis 2. Single point of access which will deal with your call and not tell you to contact a different service. A ‘handshake’ not a ‘hand off’ /7/365 response to crisis with the following standards: Emergency < 4hours Urgent < 24 hours Routine plus < 7 days Routine < 28 days Provided by a newly created Rapid Response function (as part of home treatment team) 4. Home treatment rapid response available to all referrals who require it. 5. Single point of access can book and change appointments 6. Standardised triage and trusted assessments improves continuity of care and access to the right service

6 Sharing learning – the SPA is a key part of improved crisis response Referrals The SPA went live on the 3 rd of November and offers 24/7/365 provision of an initial response service to manage and register all urgent and routine referrals, deal with queries, undertake clinical telephone triage, give advice, book appointments and signpost service users. Important to get a phone referral for all urgent and emergency situations, alongside . Develop a culture of ‘no wrong front door’ Managing an advice/support line alongside a triage service is challenging Overnight change to referrals received by not fax As expected recruitment is challenging Takes time to bed in but positive feedback from GPs – creates confidence that patients can get back into service easily

7 What next? Continue to co-produce with all partners Continue to plan change over next 1-5 years– with a detailed plan for 2016 Build on recommendations of Crisp report and Mental Health 5 year forward view Evaluate, evaluate, evaluate – and build on the great work to date Recognise good local work that can be shared across our population of 2 million Think about the whole crisis pathway – including prevention, what happens in wards, the different routes in and the different blocks to getting out. With a focus on recovery