Classification: Official
Publication reference: PR00007_i

To:

• Integrated care board chief executives
• Mental health trust chief executives
• Ambulance trust chief executives

cc:

• NHS regional directors

Dear colleagues,

Going further on our winter resilience plans: more detail on mental health actions

Firstly, thank you to you and your teams for the incredible hard work you are doing to prepare for what is going to be a challenging winter. Nationally, we have already made over £10 million additional funding available to support with addressing locally identified pressures in the mental health system.

Following the system-wide letter on 18 October from Amanda Pritchard, Julian Kelly and David Sloman in October, I am writing to provide more detail on the priority actions that all systems need to take this winter to ensure the NHS can best support people with mental health needs. Further to the above, to support system-wide focus on reducing delayed discharges and avoidably long length of stay in mental health inpatient settings, a mental health specific discharge challenge has now been launched. More information is available on our website. 

Further information on implementation, including case studies, can be found on our website here:

• Strengthening ambulance response to mental health need:
  • Given the current pressures on the ambulance service, it is critical that multi-disciplinary mental health professionals are deployed to support 999 mental health demand across all ages on a 24/7 basis (either co-located or remotely from 999 call centres) over the winter months.
  • We would like to remind all ICBs that this is already a deliverable of the Long Term Plan and not a new ask. However, in 2022/23, the third year for which funding is available, many ICBs are yet to invest as expected in embedding MH professionals in 999 control rooms, and so this must be prioritised during the coming winter and into the longer term. 
• Optimising flow through mental health inpatient settings:
  • It is not acceptable to delay an emergency mental health admission while determining which area has clinical and financial responsibility for the care of an individual. In alignment with service condition 6 of the NHS Standard Contract, if someone becomes unwell away from where they are usually resident and they require an emergency admission to a mental health inpatient unit, this should be arranged as quickly as possible, and without delay caused by any financial sign off process.
  • Further to the above, to support system-wide focus on reducing delayed discharges and avoidably long length of stay in mental health inpatient settings, we will also be launching a ‘Mental Health Discharge Challenge’. More information on the Challenge will be shared soon. In addition, £500 million is being made available to support hospital discharge over the winter period and discharge from mental health inpatient settings is in scope for this funding.
  • Optimising inpatient flow should be a core aim across the whole range of the mental health pathway, including specialised inpatient provision so that the ability to move up and down the pathway is ensured according to patient need.
• Raising profile of 24/7 urgent mental health helplines for all ages:
  • All areas now have a 24/7 urgent mental health helpline in place following a huge effort locally during the COVID-19 pandemic to stand these up. To ensure these lines are being used effectively it is critical that:
    1. All local Directories of Service (DoS) are updated in relation to mental health for 999/111 operations centres to include the 24/7 urgent helplines and other crisis support services.
    2. The profile of these lines and other complementary crisis support services is raised through local communications campaigns.
• Supporting children and young people with mental health needs in acute/paediatric settings:
  • All areas are encouraged to adopt the new integration framework for systems to support children and young people (CYP) with mental health needs within acute paediatric settings, and to take up Health Education England commissioned CYP crisis telephone training to support Crisis Mental Healthcare staff (scheduled to commence in January 2023).

Thank you again to you and your teams for your continued hard work, and for your commitment to leading strong partnership working across the system.

Over the coming weeks and months, we will continue to share best practice and learning to support local efforts to ensure that people with mental health needs are able to get the help they need this winter.

Yours sincerely,

Claire Murdoch CBE, National Director for Mental Health, NHS England.