1. The Initial Response Service for Sunderland and South of Tyne Improving access and how this fits in to the objectives of the Crisis Care Concordat, providing emergency and urgent care. Helen Pike – Community Clinical Manager for Access and CRHT services Rachael Winter- Clinical Lead CRHT Sunderland

2. Overview Context IRS Model Development IRS Evaluation/ Outcomes Other key services key to the Concordat

3. The Service Model Review

4. Access Phase 1: The case for change Sunderland was chosen as the 1 st location for the development of a new urgent access model following discussions with service users, carers, GPs and commissioners. Like a lot of areas there were: Problems getting through to Crisis Team by phone as Triage saturated++ Overnight and at peak demand times callers could wait hours for a return call from a clinician No ready point of access for Older People or People with a significant Learning Disability seeking Urgent Advice/ Intervention Fewer than 35% of referrals needed a admission/ home treatment Most of the non-crisis referrals required advice/ signposting but at low risk/ acuity

5. Large scale events- Local Authority, GP’s, Commissioners, Service Users Focussed Group Events- Service Users, GP’s, Staff, 3 rd sector. Series of design workshops Ongoing engagement through and after implementation Engagement

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

7. Phase 1: The Model IRS to offer 24/7 Universal telephone access for requests for urgent help. No restrictions on who could refer Triage and Routing over the phone- (Mental Health and other local Services) Face to Face Triage (Rapid Response) if clear plan cannot be determined over the phone Seven Band 6 Nurses for Telephone and Rapid Response Five Band 3 Nurses for call handling and Rapid Response Use of digital dictation and 3G laptops for clinical documentation Flexible interchangeable roles and rotation between Crisis Team and IRT roles dependant on demand.

8. Phase 1: Benefits of IRS Quick and efficient responses to requests for help Effective routing to the correct services in and out of NTW Flexible and collaborative working systems implemented Reduction of clinician administration burden, and freeing time to care (mainly through adoption of mobile digital dictation) Improving personal and clinical outcomes for people in crisis with mental ill health by reducing admissions/ MHA detentions, improving patient safety and patient experience

9. Evaluation-IRS in numbers Typical weekly activity 1500+Incoming telephone calls 1000 Total Contacts 400 Home-based Treatment contacts 50 Crisis Assessments 100 Rapid Responses …and growing 90% calls answered within 15 seconds >98% within 3 minutes (Average=9 Seconds) >80% rapid responses achieved in under one hour

10. IRS Referrals (Q3 2013) Other includes: Self Harm Team Acute Care Trust NTW Inpatient Ward Ambulance Consultant Psychiatrist Residential Care Facility Drug and Alcohol Services IAPT Member of Public EDT Probation

11. Service Feedback Service User and Carer GP Wonderful support! You listened and told me what to do Fantastic – a huge improvement!! You should have done it before Staff More manageable Skills are valued A lot happier Spend more time You are all very dedicated, patient, compassionate people Keep this very valuable service going The service is responsive and friendly I felt listened to and was delighted I cannot imagine where I would be today if you had not been there for me. You do an amazing job! I couldn’t have got this far without your help

12. Impact on acute bed-usage Launch of IRS- South only

13. Phase 2 IRS Model Urgent Routine Huddle Triage Team Single Point of Referral Non- complex Clinical Diary Complex Clinical Diary 11 Triage & Action IRS Rapid Response Nurses UCT OPS LD ICTS Home Based Treatment Assessment Gatekeeping

14. Other Key Services in Sunderland: High spec (RAID-esque) Psychiatric Liaison Team (Jan 2014) Street Triage (from Sept 2014) Court and Custody Diversion (2013) Transformation of Community Pathways (PCP- late 2014) Home treatment alternatives for patients with LD/ OPS service needs- ongoing Extended Hours Urgent-Care Consultant Working- (Nov-2014)

15. IRS developed in a context of shared goals with commissioner and wider partners IRS shown to vastly improve access & responsiveness with widely positive feedback Crisis Care and Access cannot be improved by one- service alone- needs a networked- collaborative response Summary