As the Mental Health Taskforce launches its strategy, Bradford District Care NHS Foundation Trust reveals how an ambitious redesign paid off for patients and partners.
A radical rethink about urgent mental health care in Bradford has ended its reliance on out of area beds, delivered 24/7 crisis care and transformed the way partners work together.
In 2014-15, out of area acute beds cost Bradford District Care NHS Foundation Trust £2 million.
Since March last year, no out of area placements have been needed and the money saved will be invested into local services thanks to its reorganisation and the launch of First Response in February 2015. A&E mental health visits have also fallen.
Accessed through a single phone number, First Response is the patient gateway to all urgent mental health and social services in Bradford, Airedale, Wharfedale and Craven.
Mental health practitioners are embedded within the police control hub and First Response also provides support to the emergency services, criminal justice system and local authority.
People in crisis can ring for help from trained staff, who identify the most appropriate action to take. This could be an assessment by an advance nurse practitioner who can prescribe or admit to hospital, a follow up with another mental health team, a GP or from social and third sector services.
First Response is also the route into The Sanctuary, which is run by Sharing Voices and Mind in Bradford as a safe haven from 6pm to 1am, easing pressure on A&E. It has received more than 540 visits since opening in May 2015.
“There was a really strong case for change for a number of reasons,” said Debra Gilderdale, Deputy Director Acute Care Services at Bradford District Care NHS Foundation Trust, said. ”There were high numbers of people who were presenting in A&E, GPs complaining about not having strong crisis services out of hours, and people were in custody for too long.
“As an organisation, it was clear we needed to do something different.”
The revamp began in 2014 when the partners began looking at how to offer 24/7 crisis care.
Mark Vaughan, mental health lead at Bradford City CCG, said: “Things weren’t being managed particularly effectively, so we called a meeting in the context of the Crisis Care Concordat but also in a local context and said, ‘let’s talk about what’s going on, review what’s going on’. It was multi-agency, with the trust, police and local authority.”
The Crisis Care Concordat partners used the Initial Response service in Sunderland as a template but looked at what else was needed locally, such as self-referrals. Commissioners approved plans for First Response and provided £500,000 for a pilot.
At the same time a review of acute mental health services confirmed the scale of bed occupancy problems which meant staff were battling to arrange out of area beds for an average of nine patients per day, and as far away as Scotland or Devon.
New systems were developed so no patient can be admitted without a target discharge date and being assigned a named consultant to oversee their care. Weekly directorate meetings, including social workers, assess each patient’s progress.
The intensive home treatment team was moved along the urgent care pathway to focus on those more severely ill, managing the step up or down for people who need treatment in an acute ward.
City of Bradford Metropolitan District Council committed money for a dedicated housing social worker to support the work, and delegated part of its budget. Mental health practitioners can now arrange temporary accommodation in an emergency or for those with nowhere to go after leaving an acute ward.
And in May last year, System Resilience Group funding of £169,000 was used to develop The Sanctuary where distressed people can be sent by First Response to get safe support from trained experts by experience.
The teams all work together in an extended hub at Lynfield Mount Hospital, which further improves relationships, and regular cross-system meetings ensure issues are resolved quickly.
Debra Gilderdale added: “If we hadn’t undertaken all the redesign, it wouldn’t have had the impact it has had. If we’d worked solely on home treatment, it wouldn’t have been as successful and if we had just focused on the wards, it wouldn’t have had the impact on productivity.
“We’ve also really built up relationships and built on the understanding of those relationships. It’s vital, those are the building blocks that allow you to push, push, push.”
As well as saving on the costs of out of area beds, A&E visits are also falling. From January to September 2015, Bradford Royal Infirmary saw 555 patients, against 927 over the same period in 2014. At Airedale District General , 430 patients were seen in A&E from January to September 2015, against 514 the previous year.
Jan, 52, who has bipolar and borderline personality disorder, had previously ended up at A&E during a crisis.
“I think First Response is a service that every area needs,” she said. “Before it started, when I used to get suicidal or self-harmed, I would contact the helpline number and they would contact the police and I would end up in A&E with someone guarding me. That stress doesn’t help.
“Speaking to First Response makes a massive difference. I don’t always understand my illness so having someone that does have empathy, does have that knowledge who I can talk to about how I feel makes a massive difference.”
Geraldine Strathdee, NHS England national clinical director for mental health said: “Bradford’s urgent care overhaul shows what integration and partnership can achieve. The trust and its partners have committed to making this transformation together and, as the work goes on, this will make sure people in crisis get the help they need, when they need it, close to home.”