The Trust Strategy 2021 to 2026 was launched in September 2021. The vision and values outlined in the Trust Strategy are supported by six strategic priorities, which outline key areas of focus for our Trust. This report provides progress against the six priorities since the last Board meeting.
Priority: We will put service users at the heart of all we do, supporting effective care, recovery and wellbeing
New gym facility at Chorley
The light welterweight boxer from Chorley was invited to cut the ribbon at the official opening in June.
It’s a Chorley inpatient resource which can be accessed by service users at our Worden, Avenham and Duxbury Wards (all based at Chorley Hospital). The gym has been installed in a dedicated outdoor wellbeing courtyard.
Initial Response Service
The Initial Response Service (IRS) Programme has made excellent progress since April 2022, with the Pennine IRS centre based at The Mount, Accrington going fully live and the Central and West centre based at Avondale, undertaking their soft launch on the 18 May 2022. With these centres now operational, there has been positive feedback from all stakeholder groups regarding access to services, quality of service delivery and feedback relating to the friends and family test feedback submitted by users following their call to the IRS.
There is further positive evidence relating to the average call answering time across the IRS services of 10 seconds and an extremely low call abandonment rate of 2.4%.
In Pennine, services are handling 25% more initial referrals and self-referrals following the launch of IRS.
The increase in initial referrals in Central Lancashire has been a more modest 2% following the initial launch of IRS, but we expect phase two, when the service opens to self-referrals on 6 July, to see an increase in rates of access.
Street Triage has proven to be a particularly important development as part of the IRS model in Pennine, with mental health attendances at acute trusts reducing by 10% since Street Triage began (as police are less likely to depend on A&E for mental health advice) and the use of s136 by the police in Pennine Lancashire reducing by 33%. Street Triage is planned for Central Lancashire in September 2022.
Locations continue to be explored for suitable accommodation for The Bay and Fylde IRS sites.
Refreshed Trust website is live
Our newly refreshed Trust website is now live. The communications team have been working with colleagues and service users over the past few months to create an accessible, modern and user-friendly website which improves the overall user experience for all who use it.
You’ll notice a much more vibrant and image-led look with additional features, greater customisation and a better mobile experience.
We are continuing to see increased levels of demand across most of our services.
- District Nursing demand is now at similar levels to that seen in May and June 2021, and year-to-date is 18% higher than pre-Covid 2019 average.
- Demand on Treatment Rooms (lower level interventions) is similar level to 2021, and year-to-date is 69% higher than pre-Covid 2019 average.
- Stroke Services have seen a spike in demand in June, whereas COPD referrals have fallen to a level last seen during the initial phase of lockdown, outside the bottom of the typical expected range of referrals.
- CAMHS demand this year (January to June) has been 15% above 2021 levels, and 55% higher than pre-Covid
- With a similar picture for Eating Disorder service demand which is 16% higher than 2021 rates, and 103% higher than pre-Covid, though has notably eased in June 2022.
- The surge in routine Adult Mental Health referrals that began to materialise in early 2022 has continued and, in fact, increased in June. In part, this reflects easier access via the IRS model, but the underlying demand has increased, and demand is 17% higher than the pre-Covid rate.
- Having seen an easing in demand earlier this year (compared to 2021), Home Treatment Teams have been busier in the last three months than the same period last year, though they have seen 3% less demand for the year as a whole. Overall, compared to pre-Covid 2019, Home Treatment demand is 11% higher for the year to date.
- Similarly, referrals to Mental Health Liaison Teams in Acute Trusts are not quite as high as last year (8% lower for the year to date) but are 11% higher than pre-Covid levels.
- Older Adult Community Mental Health demand is the one area where we have seen notable reductions compared to pre-Covid levels, with demand this year 36% below pre-Covid referral rate.
- Bed requests for Adult Inpatient Wards have now eased back to levels comparable to pre-Covid, reflecting some of the easing in Mental Health Urgent Care demand, and the improved gatekeeping measures we have put in place. This easing is seen from December 2021. Demand is still 7% higher than same period in 2019, but 18% lower than the 2021 rate, with the reduced demand in June 2022 notable.
Right Care, Right Time
Quarter one of 2022/23 has seen the launch of our Right Care, Right Time (SAFER/Red2Green) flow collaborative, improvement training being delivered on Trust Induction and the impending launch of our AQuA-accredited Improvement Reward and Recognition scheme for teams across the Trust.
Continuing the excellent work from the LiA Red2Green Improvement programme, we launched the Right Care, Right Time collaborative at The Harbour in April. We have worked with Meridian to ensure connectivity between this improvement collaborative and the wider piece of flow work they are conducting, to ensure there is no duplication. The collaborative launches in The Bay in July, Pennine in September and then Central and West in October.
We declared an OPEL 4 escalation earlier this month in response to pressure within our urgent care pathways; allowing the Trust to bring all our partners in Lancashire and South Cumbria together to take additional steps to maintain safe services for patients and help us cope with growing pressures.
With active support and mutual aid from partners, everyone mobilised quickly to support in moving our patients to the most appropriate place as quickly as possible.
The multi-disciplinary team approach across whole pathway worked well but further work is needed to ensure sustainability when returning to “business as usual”.
Initial data showed:
- 15% of patients awaiting admission on the day OPEL 4 was declared were supported in accessing alternatives to acute admission.
- Of 14 patients in A&E or 136 suites, 7 patients were known to services and 7 patients were new presentations. Further work is ongoing to understand any missed opportunities for patients known to services.
Evaluation of OPEL 4 still ongoing to understand the final lessons learned.
The Trust recognises the continued efforts of colleagues and partners for their hard work in this respect, and thanks them.
Break the Cycle helps us to drive improvement
With engagement from operational and clinical teams, the Trust committed to an improvement week at the end of May which focused on patient flow and trialing new ideas and initiatives to ‘Break the Cycle’ ahead of the long bank holiday weekend including:
- Senior clinical reviews of our patients in out-of-care placements, with a real focus on working towards repatriating our patients closer to home
- Multi-disciplinary Discharge Events (MADE) across our inpatient sites
- Home Treatment in-reach reviews on our wards
Working with partners across the system many changes were introduced across the Trust to support bed management and improve the patient experience resulting in:
- 56 discharges from Trust and out of area placement (OAP) beds
- 11% fall in the total number of A&E, S136 and Mental Health Urgent Assessment Centre breaches compared to the first three weeks of May
- 37% fall in A&E breaches
- 33% reduction in the number of people waiting for a bed
All this was achieved whilst managing the highest level of demand for beds since December 2021.
NHS fast tracks mental health support for millions of pupils
More than 2.4 million children and young people now have access to mental health support in schools and colleges, thanks to the NHS fast tracking services to help address record demand.
The NHS rollout is already one year ahead of schedule – more than 500 teams will be confirmed ahead of the April 2023 ambition with millions able to access help when they need it.
NHS mental health support teams are now in place in around 4,700 schools and colleges across the country, with 287 expert teams offering support to children experiencing anxiety, depression, and other common mental health issues. A further 112 teams are in training and will start over the next year, with an additional 104 new teams starting their training in 2022/23, taking the total to more than 500 across the country.
Five additional Mental Health Support Teams (MHSTs) are now operational across Lancashire and South Cumbria improving access to advice and early help, supporting prevention and early interventions. The Change Talks programme of in school mental health support is working collaboratively with the MHST’s to increase access and expand the spread.
Mental Health Act Reforms
The Department for Health and Social Care published their draft Mental Health Bill, on June 27 which will reform the Mental Health Act 1983.
The draft bill is designed to reduce the number of detentions, tackle longstanding racial disparities in the use of compulsory powers and end the detention of people on the sole grounds of them being autistic or having learning disabilities. The draft bill is welcomed but we need to ensure funding for mental health services follows due to ever growing need and demand for services.
The draft bill will be subject to pre-legislative scrutiny in Parliament – with a committee expected to review the Bill and report in late autumn.
The Government plans to respond quickly to this report, amend the Bill in line with its recommendations, and introduce next year. Commencement (i.e. the law starting to take effect) will take place starting mid 2024/25, and will run to 2030/31.
Response to Industrial Action
Staff employed by OCS, who deliver facilities management services at some of our sites recently voted in favour of taking strike action.
Planned strikes took place on Wednesday 29 June, Thursday 30 June and Friday 1 July.
The action relates to an ongoing dispute with OCS regarding pay and alignment with NHS Agenda for Change terms and conditions for OCS employed staff.
The Trust has regularly and continues to, engage with OCS and Unison to understand their positions.
As a result, and in addition to the current contractual arrangements, we have made significant additional investments to achieve salary parity for OCS staff. This brings salaries for OCS employed staff in line with the NHS scale and above the National Living Wage
The majority of sites were unaffected by the planned industrial action which impacted catering and cleaning services at eight sites.
Patient care and safety is our priority and we enacted robust contingency plans to make sure patients received meals and our high standards of cleanliness and care were not adversely affected by the action.
We are continuing to transform our community mental health services in conjunction with partners. Lancashire Mind have closed their engagement survey and started face to face workshops to understand what service users, carers and the general public would like to see in the new model of care.
The Peer Support service specification for Pennine, Central and West and Lancaster has been released with Red Rose Recovery awarded the service in Pennine and Lancaster and An Inclusive Future awarded the service in Central and West.
Personality disorder, eating disorder, rehabilitation and physical health/medication support pathways and workforces have been developed and the older adult’s services have drafted an options appraisal for their involvement in the community hubs.
Community Mental Health Framework can you put this as part of the community transformation above
In July 2021, NHSE released a position statement clarifying that the Care Programme Approach (CPA) had been superseded by the Community Mental Health Framework. At that point, the Trust had already commenced exploration of DIALOG+ as a new model to facilitate this move from CPA towards a more meaningful, intervention based model of care.
The first phase of implementation is due across four Community Mental Health Teams and nine Home Treatment Teams in October 2022.
DIALOG+ is an evidence based model of care that is based on quality of life research, concepts of patient-centred communication, components of solution-focused therapy and is supported by digital technology.
To support the move to DIALOG+, new Care and Safety Plan templates have been developed in collaboration with service users, carers and staff; these are designed to be much more person-centred and user friendly focussing on what service users and carers want from care and safety plans.
The Clinical Senate has agreed that Mental Health services will move to these new Care and Safety Plans on 1 September 2022 and over the summer there will be learning sessions to facilitate this transition