Since March 2020, trusts across the country have been working around the clock to protect staff and patients from the new risks posed by COVID-19. In just a matter of weeks, they had to adapt their ways of working to continue delivering mental health care. In this case study, NHFT’s team reflects on the past few months and what they’ve learned from working in mental health during the COVID-19 pandemic.

Angela Hillery, Chief Executive at NHFT, said: “We are proud to be an outstanding provider of community and mental health services, and we are dedicated to working with our colleagues, patients and service users to ensure that we are resilient through change to continue to provide compassionate and quality care.

“Throughout the pandemic we have worked together to adopt innovative ways of working, expanded our teams and adapted new solutions to keep everyone safe, and continue to provide vital mental health services to our communities. We will continue to reflect, learn and implement changes for our patients.”

New ways of working

Throughout the pandemic, the Trust developed new ways of working including creating digital solutions. There was a shift towards virtual visiting, where all wards had iPads and smartphones for patient use so they could keep in touch with loved ones. Microsoft Teams was rolled out across all areas of the Trust, giving teams the ability to meet virtually when required, increasing contact between units.

New hospitality assistant roles were created, predominantly seeking candidates from the hospitality industry, to support patients making their bed and provide food and drink. The training for these roles was delivered remotely. This resource was used to support and alleviate pressure from existing staff and ensure high levels of patient engagement. Hospitality assistants also lead on social activities. These roles were really successful and allowed the ward-based staff to undertake their essential tasks, while patients felt supported and listened to.

Despite the pandemic, NHFT ensured that all patients and service users received outstanding and compassionate care. With this in mind, it continued to hold its patient experience groups and carers groups virtually. It allowed staff not only to capture feedback but also to be responsive. Recognising that changes were made quickly, there was a need to review what was working and what could be improved. Today, teams still continue to operate a co-production and recovery group allowing for new processes to be co-produced. For example, the patient experience group was pivotal in co-developing guidance in relation to patient leave from mental health inpatient wards during COVID-19.

Supporting staff

New operational guidance was released and updated frequently, which involved making several changes to the Trust operational processes. The biggest challenge was keeping staff up to date with ever evolving processes and new ways of working. Moreover, as expected there was a significant increase in COVID-19 related absences but teams managed to cover most shifts, thanks to bank and redeployed staff. Despite tremendous pressures, all staff members demonstrated a high-level of dedication and professionalism and continued to care for every single patient that needed care during this difficult time.

Implementing strong IPC measures across the Trust was also critical to protect and reassure staff, who were worried about themselves, their families and their patients. Many team members were vulnerable, for example as a result of their ethnicity or from underlying health conditions. Recommendations on PPE were made based on the risk caused by procedures as well as staff’s vulnerabilities. This reassured staff that they were being listened to. There was also an increase in the visibility of infection control staff that were coming onto inpatient wards to provide support and information on IPC measures, which provided further reassurance to all teams.

Protecting vulnerable patients

There was a huge effort at the start of the pandemic to discharge patients whose care could be provided in the community, where they would be less at risk of being infected by the virus. As a result, NHFT had numerous vacant beds for the first time in years which facilitated social distancing and the reorganisation of wards and units.

There were some major changes to the admissions process, with patients having to undergo testing and isolation before being cleared to move on to what were called ‘green wards’. Thanks to rapid-testing, this procedure could then be sped up; making sure people could access mental health care faster.

There was also a huge emphasis on informing patients about COVID-19 prior to arrival, including what to expect if they became symptomatic. The Trust wanted to ensure patients were informed and engaged throughout the whole process, even before their hospital stay, or during their leave.

The Trust reported increased acuity of patients being admitted into mental health wards. People presented to services very unwell, particularly as lockdown progressed. Teams were seeing many new patients for the first time, or patients who hadn’t had contact with them for years. Some admissions were clearly related to the effects of lockdown. There was a resistance or inability from some patients to follow infection control procedures, particularly those who were acutely disturbed. This required staff to make individual decisions based on the risk of infection and the need to ensure the protection of the patient.

The Trust is working with service users and carers to ensure that everyone is kept safe by following infection prevention measures. The Trust has embedded coproduction in the planning and delivery of services and recognises that some people may be resistant to these unprecedented changes but working in partnership means they can listen and respond to any concerns and deliver face to face services. By working together to follow infection control procedures NHFT has been able to keep everyone safe during these challenging times.