The mental health landscape is still reeling from the effects of the pandemic. Patients who did not come forward during the height of the pandemic are now presenting to their GPs and many have experienced deterioration in their mental health over the past two years. To make matters worse, the growing cost of living crisis and concerns around global affairs are compounding existing issues – and creating new ones.
1.58 million people were in contact with mental health services at the end of February, and more were waiting to be seen. Clear visibility of waiting lists, the number of patients currently in contact with the service, and how quickly patients are moving from one touch point to the next is essential to streamlining services.
Derbyshire Healthcare NHS Foundation Trust and RwHealth – a supplier of NHS data analytics – recently held a Mental Health Leadership Strategic Round Table to delve into the challenges facing the sector and explore possible collaborative solutions. This event provided a fantastic opportunity to discuss systems and solutions that will help a better experience for patients and staff alike.
Most importantly, it was an opportunity for staff to challenge one another to think differently about the challenges the sector faces – and the impact any possible solutions will have on those who rely on them.
Redefining ‘discharge’ from services
Discussion at RwHealth’s roundtable revealed that the phrase ‘discharge’ perhaps carries more weight than one might expect. When staff think of discharging a patient, they often see this as the end of their role in the patient’s care. The reality for the patient is simply a transition to the next stage in a journey that is far from over. Handovers should thus be seen as a transition rather than an endpoint, moving away from the old habit of considering different elements of the care continuum in isolation.
Perhaps ‘discharge’ would be better reframed as a ‘transfer of care’ as that better describes the reality and fosters the thinking of shared responsibility. Every person across the health and social care system is collectively working toward the same goals, and only by realising this will the NHS successfully address the occupancy issues at hand.
Engaging and involving patients
Attendees at the RwHealth event raised the possibility of hosting similar roundtables with patients in attendance – after all, creating services that truly meet the needs of their target population involves bringing patients to the table.
This would also provide a great opportunity to educate the population about the services available to them and highlight that admission to the hospital may not always be the most helpful route.
A key part of reducing patient reliance on acute care is supporting people to take care of themselves in the home as this is often a better environment for patients. However, it is also crucial that services acknowledge that home may not be the best nor safest environment for some patients and are able to support them accordingly.
Education regarding the most appropriate form of care is not only required for the public, it’s needed within the healthcare sector too. Referrals are too often made simply due to a lack of knowledge around alternative options. If other areas were better informed on how to support and efficiently signpost patients to appropriate services in a timely manner, reliance on urgent inpatient mental health care may be reduced.
Out of hours care
Out of Hours (OOH) services can be quite disjointed, making it all too easy for patients to be left behind.
OOH shifts – which make up 70% of the day – are often left to junior staff, despite the fact that it is usually the most complex cases that require OOH care. Enhancing OOH care and securing a more senior presence would help ensure patients are achieving the best possible care, irrespective of the time of day.
These hours create additional challenges when trying to work with other elements of the care system; the rest of the system does not consistently work OOH, meaning that OOH discharges will be left in limbo until ‘normal’ working hours – often at the detriment of patient wellbeing.
As well as presenting staffing and care challenges, demanding hours are far from appealing to potential new talent. The NHS must consider how to attract – and retain – staff with the expectation of working such unsociable hours. Enabling staff to focus on the core responsibilities of their roles is key to maximising the workforce the NHS currently has.
Healthcare staff take patients’ lives in their hands each day, so the workforce is naturally risk-averse. However, this is not always a good thing as it often means a reluctance to change for the better. The workforce often mistrusts new strategies and pathway changes, perhaps delaying the implementation of changes that could be hugely beneficial. Finding a balance of innovation and sensible caution is tricky, but essential.
Using data the right way
Data can drive decision making at every level, from procurement to front-line staff. Together, attendees explored how trusts can ensure all actions are backed by their own data and how this can help identify unwarranted variation – both internally and between organisations.
Conventional data presentation, however, can present major barriers to its use. For example, many do not respond to data presented in an excel spreadsheet; ensuring that data presentation is interactive and easy to consume will support people to utilise it effectively.
In the absence of easily accessible data evidence, it’s easy for weaknesses and failings to hide in plain sight. It is absolutely essential that everyday insights are gathered and displayed in ways that make them easy to refer to every day so that they can truly have a constant impact on trust performance.
Find the full report here.
About the RwHealth and Derbyshire Healthcare Foundation Trust partnership:
With a focus on improving flow and the entire patient experience, this partnership was founded on the premise of integrating data into the culture of managing and streamlining patient flow across the entire system.
RwHealth and Derbyshire have jointly worked to support clinical, operations and leadership teams at the Trust, in order to see the optimised management of critical services and flow. To date, this has been achieved through the continuous use of data, analytics, innovation, clinical engagement, operational engagement and transformation support.
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