The PSC news-insights: entry

02/07/2021

A matter of days or weeks – what can Mental Health and Acute Trusts learn from each other? 

The PSC Performance team hosted a roundtable to bring together experts across Acute Physical Health and Mental Health to discuss what they can learn from each other to offer high quality and integrated care.

We were thrilled to host a panel featuring:

- Liz Durrant – Deputy Head of Mental Health, NHS England
- Jenny Erwin – Director of Transformation for Mental Health, Hampshire & The Isle of Wight ICS
- James Lowell – Chief Operating Officer, South London and Maudsley NHS Foundation Trust
- Charlotte O’Brien – Director of Integration and Partnerships, Sussex Partnership NHS Foundation Trust

It was fascinating to hear what concepts are applicable between mental health and acute physical health settings to increase patient flow and foster collaboration, but importantly, also where the limitations in learnings are.

If you have any thoughts on this topic or would like to join a future roundtable focused on learnings between acute and mental health settings, please get in touch with chris.bradley@thepsc.co.uk. But in the meantime, we wanted to share some of the key learnings from our dicsussion...

A matter of days or weeks – what can Mental Health and Acute Trusts learn from each other? 

What can Mental Health learn from Acute Trusts when it comes to patient flow?   

"The needs of inpatients in physical and mental health settings contrast greatly. For physical health, length of stay for some patients tends to be a matter of days. For mental health, length of stay might be a matter of weeks. Rhythms and pace of work are therefore very different." - James Lowell 

The principles of good patient flow used in physical health settings can often be usefully applied to mental health. Our speakers identified two major areas in which there is still disparity: standardised approach to discharge planning and availability of data.   

The following were raised as examples:  

  • Effective use of patient discharge principles such as Red-2-Green on inpatient wards  
  • Use of greater network links with community and primary care as well as ambulatory and police services in the system  
  • A more frequent rhythm of working including a 7-day provision  
  • An MDT-led approach to determining when service users become “fit-for-discharge” considering both medical and social determinants underlying their wellbeing  

Use of business intelligence and a data-driven approach remains a major gap in mental health compared to physical health settings. There was an agreement that more data would be useful for mental health settings, although there is a significant amount of work to be done for appropriate measures to be gathered in a standardised manner.   

 

What can Acute trusts learn from Mental Health Trusts when it comes to collaboration?   

"By collaborating with teeth and grit, we're removing the artificial divide that previously existed between providers." – Liz Durrant   

Mental health leads the way in emphasising user experience in service design, as well as in their strong collaboration between local providers to ensure the best care for their service users. No other setting has placed users at the board-level for decision-making processes; this is progress that is unique to mental health.   

The NHS-led Provider Collaboratives is an example by which the structure of services has been redesigned to think of patient needs in a holistic, service-user centric manner. With strong collaboration between local providers, this initiative has enabled localised solutions for specialist mental health care which emphasises population health. This sets a great precedent for how we can effectively challenge the current set-up of patient pathways and implement a new approach to system-wide collaboration. There is exciting work to be done in applying these transformations to a wider range of services at a national scale in the future.   

 

Some of our speakers highlighted the limitations of what the two can learn from each other

"The level of risk carried by mental health providers is very different – it goes without saying that it is extremely risky to discharge at the wrong time and or without the right support." - Charlotte O’Brien 

Regardless of the similarities listed above, the speakers suggest that what is considered good practice for service users in physical health settings is not necessarily best for the patient in a mental health setting. For example, limiting patient time in hospital is widely agreed to be beneficial in physical health. 

However, in mental health settings where so much of the treatment is dependent on therapeutic relationships, there are big costs to a shorter time spent in the patient pathway. Without true therapeutic impact, discharges can be extremely risky for vulnerable patients. This emphasises the importance of bringing service user experience at the core of service design, particularly when principles are borrowed from other healthcare settings.   

There was a passionate agreement at the roundtable that we must continue to challenge our current pathways and think outside the box by asking the question: what can service users truly gain from their time in hospital, and can they receive better care elsewhere?   

"Instead of talking broadly about what the NHS should do next and together, we need to focus on how we should be. Extreme pragmatism will be required from us all if we are going to determine a long-term approach to working in systems and genuinely collaborate " - Jenny Erwin 

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