1. Integrated Urgent Care System: Mental Health crisis response (Single Point of Contact)
Confirmed attendees (as of 31/01/2017)
Address
Organisation
Anderson Claire
Plymouth City Council
Bray Nicola
NEW Devon CCG
Burton Kerry
Clasby Tracy
Livewell Southwest
Collins Chris
Devon County Council
Cordy Martin
Dale Kerrie
DPT
Faircloth Emily
Fitzsimmons Elaine
Gale Jim
Devon & Cornwall Police
Gardner Cathy
Torbay & South Devon NHS Foundation Trust
Hill Vicky
Virgin Care
Hinsley Sharon
Northern Devon Healthcare NHS Trust
Jones Lewis
RD&E
Keedwell Paul
McCormick Shelagh
Miller Stephen
Moore Julia
Rooke Graham
Devon & Somerset Fire & Rescue Service
Sawyer Mark
University of Exeter
Smith Miriam
Plymouth Hospitals NHS Trust
Taylor Crispin
Turl Jo
South Devon & Torbay CCG
Unstead Gill
Wenman James
SWAST
Wiggin Justin
Torbay Council
Emily Faircloth

2. Introduction and context
Key Deliverablies for Mental Health Transformation (5YFV).
By 2020:
Accountable for:
Commission effective 24/7 Crisis Response and Home Treatment Teams as an alternative to acute admissions
Eliminate out of area treatment for non-specialist acute care
‘Core 24’ standard for mental health psychiatric liaison in acute hospitals
Supporting:
Data quality and transparency
Reduction of suicides by 10%
Facilitation Notes:
Shelagh covering this slide
A welcome & gratitude to those in attendance. For those who were unable to attend, an online questionnaire will be available to contribute to the development of the SPoC. If anyone present knows of anyone who would like to / needs to contribute please either contact or share the link to the questionnaire given at the end of the meeting.
Housekeeping:
Fire drills / exits,
loos
refreshments
timings for the event
Outcomes for the meeting – ask if anyone present has anything else they’d like to cover during the meeting…

3. Crisis Care Concordat Priorities
1. Access to support before crisis
2. Urgent and Emergency access to crisis care
Ensuring people with mental health problems can get help and they are taken seriously, addressing inequalities
Increased involvement with people with lived experience and support for carers
Ensuring that mental health crisis is treated with the same urgency as physical crisis i.e s136 policy, consistent triage
Ensuring 24/7 access to crisis care via a single point of contact for all ages (111)
Safe places are available for all ages
3. Quality of treatment and care when in crisis
4. Recovery and staying well
An integrated approach to physical and mental illness (including conveyance)
Reducing length of stays with increased community support
Enhanced role of primary care and work with secondary care
Promoting and teaching resilience
Providing care closer to home
Ensure people get referred to appropriate services
Support for carers (‘Triangle of Care’)

4. Acute Care Pathway Mapping
Facilitation Notes:
NB covering this slide
Copies of the pathway map created by Alexander will be available on the walls around the room and will be used as a framework to guide the group discussions
The meeting will focus specifically on the RED areas of the Single Point of Contact part of the pathway map.

5. The Devon Single Point of Contact
Our Ambition
Plan and implement a Single Point of Contact (SPoC) to MH crisis services in Devon. (Priority 3)
Effective working interfaces with all other access points (MH providers, Ambulance, Police, FRS etc.)
Widely known and used
A clear link between the capability required in the SPoC and the ‘bill’ to organisations that will need to support it.
For the purposes of marketing and public information the Single Point of Contact will lie entirely behind the 111 service and will be a ‘person’, not a capability. E.g: ‘call 111 to talk to a person about any mental health matter that concerns you’.
Detailed design needs to be built up from individual cases and experiences.
Facilitation Notes:
Emily covering this slide
Priority 3 of the Devon Crisis Care Concordat Action Plan, developed in 2015 and revised in 2016 states our commitment to implement a Single Point of Contact.
This strategy is supported by service users and carers in “I statements” and summary of “What good Looks like”
“When I’m in a pickle I will know who to call – or someone else will know who to call – so that I can receive the best help for me..”

6. Current Service Provision
Clinical Assessment Service (CAS) based in 111 service: provided on an ad hoc basis by DPT
Mental Health Matters (Livewell Southwest): Available for patients with ongoing care. Available 5pm - 9am Monday to Friday 24/7 Weekends and Bank holidays – available for people already on caseload
Single Point of Access (DPT): Launched in 2016 with circa 250 calls per week – available people already on crisis caseload
Single Point of Access (Virgin Care):
24/7 available to those known and unknown to
service
Cornwall – people living in Cornwall will access the Cornwall 111 service (mapped via their telephone number)
Facilitation Notes:
Emily covering this slide
One could say that there is already a 24/7 crisis line available in Devon for MH crisis. However:
It is only available to people who are known to MH services (MH crisis caseload for DPT)
The number is different for Livewell and DPT – SPoC offers a universal number across Devon
There is variation across Devon in the response to MH crisis e.g out of hours operates at different times, Livewell outsources its Single Point of Access.
MH providers currently work independently
111 service provides an opportunity for out of hours MH crisis support to be equitable to working hours.

7. The case for change Current State Future State
Multiple points of access to MH services across Devon
Pathway variation between children’s, adult and older people’s MH services
Variable hours of operation and access
Variable access to clinical advice, assessment and intervention
? Support for those not known to MH services
? Support for carers and others
A 24 / 7 response, all age, single point of contact
Available to all: self referral and response to carers, GP and health & education professionals
Rapid access to advice and intervention
People are seen in the appropriate service at the right time
Improved flow and use of limited resources
Facilitation Notes:
Emily covering this slide
A summary of the current position of Devon and the future state…
To reduce:
Variation
Complexity
Bottle necks in the system
To enable:
System / service resilience
Effective response to variations in demand
Prevention of MH crisis by getting people to right places in the pathway (eventually)

8. Information Collection & Routing
Initial Response Team
South of Tyne and Wear
REQUEST FOR HELP
ROUTING
ST UCT
OPS LD
ICTS
SL UCT
GH UCT
Home Based Treatment
Assessment
Gatekeeping
Information Collection & Routing 11
Triage & Action
Gateshead
Rapid
Response Nurses
South Tyneside
Sunderland

9. MENTAL HEALTH CLINICAL ASSESSMENT SERVICE (CAS)
Person with MH need
Carer of person with MH need
GP or other healthcare professional
Member of the public
CLINICAL ASSESSMENT SERVICE
GP, A&E etc
MH Clinical TRIAGE
Telephone advice & counselling
Other disposition
Facilitation Notes:
NB covering this slide
Copies of this diagram will be available on the wall around the room
This is a DRAFT diagram to help discussion and amendments are welcome (Post it notes will be provided)
Elaine has also provided an outline model of how 111 works which could be used with this diagram
All known and unknown children in crisis
Known to any service
(Mental Health Matters)
** Expand to known to DPT
Known to crisis team or new referral to crisis **
PROVIDER SINGLE POINTS OF ACCESS

10. Key requirements for the clinical assessment service
Workforce – capacity and skill mix
Access to clinical records
Use of Intelligent Voice Recognition (IVR) to direct people immediately into the CAS
CAS community service interface – no decision made alone
Interface with existing provider Single Point of Access
Interface with pathways and services
Facilitation Notes:
E Fitz covering this slide

11. Next steps…
Further engagement to develop and agree service specifications for a Devon wide SPoC
Develop and agree the business case and mobilisation plan
Embed crisis plan in STP delivery programme
Agree timescale for launch of the SPoC
Review of Crisis Response and Home Treatment Teams
Mobilisation to include clinical workshops & training
Build comprehensive Directory of Services (DoS)
Facilitation Notes:
NB or EF covering this slide