Themes:
- Making services accessible for all
- Community-based approach
- Collaboration across the system
Background
North Staffordshire Combined Healthcare NHS Trust (North Staffordshire) is a provider of mental health, learning disability, substance misuse and primary care services. The trust provides inpatient services for adults with acute mental health needs. It has a young people’s inpatient service and an assessment and treatment ward for people with a learning disability. It is also one of the few trusts providing NHS drug and alcohol inpatient services. Working across 30 hospital and community-based sites, the trust serves nearly half a million people of all ages and backgrounds.
In line with national trends, the trust has experienced a surge in demand from children and young people. In recent years, it has seen a rise in the number of mental health crises, including through referrals from GPs.
Developing crisis care provision
Following a £1.1m investment in 2018, the trust developed a crisis care centre at the Harplands Hospital site in Stoke on Trent. This centre, opened in 2019, brings together a range of teams offering services to people of all ages. The trust believes it is unique in what it sets out to provide. The crisis care centre offers an accessible service for anyone who feels they are in distress or needs advice or reassurance. People can ring or text the crisis care number to speak to a mental health professional who will direct them to the most appropriate service.
North Staffordshire also has good links with key system partners. While setting up the service, feedback from GPs showed they wanted one referral point for patients with mental health needs. The crisis care centre acts as this central point and the trust then works to navigate patients to the most appropriate pathway. It also works closely with the ambulance service and the police who access the service via a 'professionals' line'.
The centre provides a walk-in service, and as it is co-located with inpatient services (a three-minute walk away), people can be referred on site and linked across as appropriate to their needs. Furthermore, the 'high-volume users' team works from the centre and supports patients who regularly attend A&E. There is a separate '136 suite', which can serve as a place of safety for individuals who are detained under Section 136 of the Mental Health Act, where a mental health assessment can be carried out.
Between April 2023 to April 2024, the all age access team accepted 26,774 referrals, which included routine and urgent and crisis referrals. From the crisis care service line, they received a further 10,000 crisis or urgent referrals, inclusive of community/street triage, the home treatment team, high volume users, the mental health liaison team and 'place of safety' (Section 136). Following the opening of the crisis care centre there has been an increase of 104% in contacts and a reduction in did not attend rates.
The centre has evolved since its inception to better meet the needs of the population it serves, demonstrating continual improvement. For instance, in response to patient concerns about noise levels in the reception area, quieter spaces with welcoming sofas were created. Children can now also access the service via a separate entrance and with support on hand for families to receive the care they need.
In establishing the centre, the trust recognised the challenges of bringing together multiple teams under one roof. The leadership team say it was vital to take staff along with them, highlighting the big picture and reflecting the needs of the population so that everyone was aligned on the centre's purpose.
Reaching out into the community
The trust is also doing valuable work 'upstream' on the mental health crisis pathway. It has an all-age wellbeing portal to support the self-management of mental health issues. This comprehensive online resource provides information, guidance and support for health professionals, patients and family members. There is also an electronic referral option available.
The trust is working with Communities Together Stoke on Trent – part of the national community led support programme – and a local football club, Port Vale FC, to enable early intervention and community support to help prevent people from reaching crisis point. Through the club’s community lounge, they can receive support and can be directed to the most appropriate service, whether that is a food bank, money advice, or mental health assistance. Support time recovery workers, part of the crisis care pathway, are also on hand to help link people through to the right service.
The trust covers areas with high levels of deprivation. Seldom heard populations are actively considered as part of its approach at the crisis care centre and community lounge. Feedback from Asian communities revealed that offering both physical health monitoring and a welcoming atmosphere, like a cup of tea in the community lounge, encouraged attendance, especially for those who might delay seeking help.
Working across the system
North Staffordshire's collaborative efforts with West Midlands Ambulance Services University NHS Foundation Trust have yielded significant success in reducing emergency department (ED) admissions. The mental health liaison team's pilot programmes within EDs, which divert patients to the crisis care centre, have been shown to ensure timely and effective care. These initiatives have been met with positive feedback from system partners, demonstrating their value in providing appropriate care at the right time. The trust also has strong partnerships with local authorities, which is particularly important in ensuring children and young people are not being cared for in an inappropriate setting.
Looking to the future
North Staffordshire's strategy outlines how over the next five years its services will evolve to meet the needs of the local population. The crisis care centre will be central to achieving the directorate's strategic priorities which are to:
- reduce suicide rates year by year by 2028
- reduce waiting times for services
- embed mental health services within NHS 111
- increase workforce to develop their services.
The trust says the national expansion of 'NHS 111, press 2 for mental health service' has offered a valuable new resource for patients. In the weeks following the expansion of 111, they have been receiving an average of 350 calls a month for urgent/crisis presentations. Recognising that the populations' needs are constantly evolving, the service is committed to continuous improvement and ensuring it remains relevant.
The trust would like to go further, recognising that investing in the right environment can improve patient care, but it faces significant space and capital constraints. Focusing on beds is not sufficient. Having the appropriate support and the ability to escalate care when necessary and quickly transition patients to community-based services is also vital. Adequate capital investment is essential to enabling this.