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Trust implements a clinically-led new model of care to reduce out of area placements, repatriating 64 people back to the South West

Challenge

    • 50% of South West patients requiring low and medium security were treated out of region, away from their families
    • Patients remained in secure services longer than clinically necessary, leading to higher costs
    • Provide care closer to home in a least restrictive setting

Action

    • Implemented the New Care Models programme to reduce out of area placements
    • Introduced a single point of access across the region and standardised assessment criteria
    • Implemented a regional approach to the bed management, increasing in-region bed occupancy
    • Implemented a repatriation plan, working with provider units, patients and families
    • Created a detailed planning relating to activity, flow and finances

Result

    • Reduced out-area-placements, repatriating 64 people back to the South West since October 2016
    • Improved patient experience
    • Improved the clinical and cost effective way of providing services, thereby increasing value to the tax payer

* Please describe the challenges or problems your solution set out to solve.

• One year ago over 50% of South West patients requiring low and medium security were treated outside of region, being cared for at some distance from their families. They remained in secure services twice as long than was clinically necessary, with higher costs.

• Aimed to reduce the number out of area placements by implementing a regional innovative approach to managing patient flow to reduce length of stay, and treat in least level of security.

• Informed by best practice including MH Task Force “care that prevent avoidable admissions and supports recovery…in the least restrictive setting, as close to home as possible”

* Please describe the actions you took to achieve your result.

• Successfully submitted a bid to be a wave one pilot site with NHS England

• Developed a clinically-led new model of care, with clinicians across eight partner organisations (5 NHS; 2 Independent Providers and 1 Community Interest) leading clinical work streams and contributing to the design of the overall model of care

• Active engagement in national work streams - developing prototypes in women’s services, community forensic and prison mental health care

• Introduced a single point of access across the region and standardised assessment criteria, which allowed us to admit people more quickly.

• Implemented a regional approach to our bed management, which increased in-region bed occupancy. This equates to bringing over 20 people back into care within our region

• Developed clinical networks to standardise how we deliver inpatient care, including developing a shared set of clinical and patient outcomes. These networks also enable us to share good practice and challenges with colleagues.

• Successfully proposed commissioning of extra specialist beds in region, helping to address the historical under provision of services locally

• Looked carefully at the needs of our population and identified that services for women are underprovided. We have re-profiled the use of some of our in-region beds to provide women’s services, commissioning extra female low secure beds and planning to introduce more women’s services. We are boosting community care, by developing a specification for two community forensic teams during 2017/18 and more in the future

• Implemented a repatriation plan, working with provider units, patients and families. We have repatriated 64 people since October 2016.

• Business model enabled a risk and gain share with partner organisations

• Enabled individuals to step through levels of security in a safe manner, ahead of timescales within the patients’ care plans previously treated by out of region providers

• Detailed planning relating to activity, flow and finances to enable a sustainable business model supporting the clinical model

• Set up partnership governance arrangements to ensure that all partners are able to contribute to all work streams.

• Improved the clinical and cost effectiveness way of providing services thereby increasing value to the tax payer.

• Service user involvement has been embedded at every stage within development of services, through the use of forums such as Patient Council at Langdon Hospital. In addition, service users read and critiqued the original bid to NHS England.

* Please list the most significant results

• Reduced out-area-placements significantly, bringing 64 people to-date back to the South West.

• Patient experience significantly improved. David (name changed) a man in his 30s was brought back into the South West, after four years living out of area. His family now is able to visit on a weekly basis, rather than a few times a year, he’s been engaging well in therapy and he’s recently started going out into the community, to places like the local college and library. The difference in him has been remarkable. He now has hope and can visualise a future in his own community.

* Describe how your project has spread to other teams, departments or organisations

• Work has been embedded in all partner organisations– 5 NHS, 2 Independent and 1 Community Interest.

• Contributed and shared learning in national design work streams for community forensic teams, prison healthcare, and women’s services.

• Showcased work at Royal College of Psychiatrists, national NHS England knowledge exchange events and shortlisted from over 60 applicants to showcase as one of 12 at the NHS National Providers annual conference.

• Progress influenced NHS England plans for the expansion of the New Care Models Programme, which will be applied nationally.

• Contributed to development of regional Accountable Care Systems which will reach beyond Mental Health.

Key individuals

Anne Forbes