Case studies illustrating existing good practice

There are also examples of good practice that we will continue to build our understanding of. We have shared a case study below, in case helpful:

North Central London (NCL)-wide crisis pathway

All NCL acute and community partners came together, under strong leadership, to respond to the COVID 19 pandemic. An NCL-wide crisis pathway was developed at pace in April and reconfigured during June and September to adapt to changing paediatric acute service provision across NCL, in the context of closure of paediatric departments to increase COVID capacity.

Communication and collaboration were facilitated by the creative use of technology; for example, weekly NCL-wide crisis calls were established, and demand and capacity data modelling via ICS analytics supported an evidence-based estimation of demand and consequent allocation of resources.

On call rotas were merged to increase resilience if clinicians fell ill or needed to self-isolate. Resources were used flexibly, e.g. taxi services to safely move patients between sites allowed staff to work flexibly across organisations. Capacity within the nurse-led out of hours CYPMHS crisis team was increased from 4.3 WTE to 12.2 WTE (meaning 5 people on shift 12-12 everyday 7 days a week across NCL). This allowed for faster assessment and discharge of young people presenting to the acute sites and reduction in the time spent in hospitals.

The 24/7 crisis line provided by Barnet, Enfield and Haringey Mental Health Trust, expanded to Camden and Islington.

The North and South hubs demonstrated increasing activity and successful diversion out of A&E departments, which was vital in the context of increasing demand. Community teams RAG rated all open cases and diverted resources to the most vulnerable young people to try to avert the need for crisis services. The system has now three acute sites (plus two diversion hubs) for CYP requiring urgent or emergency care.

Psychiatry liaison workforce in acute sites provide cover to A&E and inpatient wards and are supported by the Out of Hours crisis team and the psychiatry on call rota.

Good working relationships between CAMHS and paediatric teams meant that CYP presenting with complex mental health needs received safe and good quality care while in the acute setting.

If you’d like to share any innovative examples or best practice, please get in touch at england.cyptransformation@nhs.net.