After the pandemic, I observed an increase in the use of one-to-one care across my trust. Under the guidance of my deputy chief nurse, we began exploring this trend in more depth. Our work focused on identifying ways to better support patients with additional needs, particularly those with mental health challenges, including the potential use of healthcare workers with specialised skills in this area.

Our journey so far

We explored the issue further, setting up a multidisciplinary working group bringing together professionals from across the trust. The group’s initial task was to review and update the existing policy on enhanced care and developing a supporting standard operating procedure.

We then focused on quantifying usage of enhanced care across the organisation. The findings were notable with between 9,000 and 10,000 hours of temporary staffing being used to provide enhanced care each month, with agency staff accounting for 5% of this provision.

As a result of our targeted interventions, we have reduced the enhanced care demand by up to 2,000 hours per month and completely eliminated our reliance on agency staff for this purpose.

Learnings from the national perspective

Last year, I had the privilege of being invited to chair the ETOC steering group. Through collaborating with the improvement team and other clinical leaders, I’ve gained valuable insight into best practices in this area, while identifying gaps in our knowledge and evidence base.

I’ve learned that trusts should prioritise two fundamental priorities when starting out with ETOC implementation: establishing a clear policy for providing ETOC and implementing consistent data collection for patients receiving this care. These are essential priorities for effective governance and safety monitoring, while providing a baseline for continuous improvement.

I’ve also been struck by the variation across the country in the staffing models for ETOC delivery —ranging from temporary to substantive staff, and from registered nurses to clinical support workers. This variation is an area the programme is keen to explore further.

A personal highlight for me has been visiting two of the trusts in the first collaborative cohort. Seeing their work first-hand and witnessing the enthusiasm of their teams to make a real difference for patients has been truly inspiring.

Looking ahead

I’m delighted that my trust has been selected to join the second cohort of the ETOC collaborative. Having attended the launch meeting in May we are now actively preparing our key next steps: defining the focus of our improvement project and hosting a visit from the programme team in July.

While our improvement plan is still in development, several key areas are likely to feature, including:

• staff deployment models – we are evaluating whether to establish a dedicated pool of substantive ETOC staff or to backfill with temporary staff, allowing substantive staff to deliver ETOC
• staff competence – ensuring that those providing enhanced therapeutic observation receive appropriate training and demonstrate the necessary competencies
• therapeutic input for patients – ensuring that patients receiving ETOC benefit from meaningful therapeutic engagement rather than just observation