|Contact||Team Manager, CRHT / IRT Sunderland|
|Telephone||0303 123 1145|
|Address||Hopewood Park, Waterworks Road, Ryhope, Sunderland, SR2 0NB|
In April 2012 Northumberland, Tyne and Wear NHS Foundation Trust launched a new service, the ‘Initial Response Team’ (IRT) to improve access to urgent mental health care and remove existing barriers to the service.
The IRT, which complements the existing Crisis Team, has provided service users, referrers and carers with increased telephone lines into the service and more staff available to speak directly to those who make contact. The new service has led to a marked improvement to response times and an increased satisfaction amongst users.
Download the following documentation about the Sunderland and South of Tyne Initial Response Team:
- Briefing paper, published by NHS Improving Quality, Sunderland and South of Tyne Initial Response Team
- IRT report
- IRT presentation
- IRT patient information leaflet
Feedback from service users, carers and referrers, reported that crisis services were often inaccessible for those in need. High levels of calls into the service relied on a single telephone line and answerphone. Voicemail messages were responded to as soon as possible but this did mean that many callers could not always speak to someone when they felt they needed to.
The Crisis Team, commissioned to deliver assessment and support for serious mental health problems, were saturated with having to respond to a wide variety of requests not all of which were appropriate for the Crisis Team to handle. Analysis identified that only 35% of all contacts actually needed the response of the Crisis Team. Almost half (43%) of the ‘inappropriate’ contacts were for advice or help and often these were people who clearly required support and signposting but considered to be low risk of requiring hospital admission. A further 8% were referrals for assessments which were deemed inappropriate for the Crisis Team.
The team also identified that a significant proportion of clinical time was spent on the telephone collecting demographic data and completing administrative tasks. As a result the telephone was regularly engaged for long periods, leading to service users and referrers utilising emergency services and dissatisfaction with the service.
The Crisis Team were often unable to meet a locally set target of four hours from referral to being seen.
What we did
Initially the Trust engaged key partners including, commissioners, GPs, service users and carers in a discussion about the current crisis service and worked with them to identify the opportunities for improvement. The idea of an Initial Response Team began to form and after further consultation, local teams began to plan the systems and processes of how the IRT would work. The formation of the IRT formed part of a wider service review aimed at improving the experience of those in contact with the Trust services and improve service efficiency.
Working with commissioners and other partners the model of telephone triage and rapid response was initially pilot tested in Sunderland. This was supported through a local CQUIN arrangement to incentivise change. Following review and business case approval the service has since been rolled out across the whole of South of Tyne to cover all three localities. A number of staff were appointed to support the IRT including five band 3 nurses to support the additional call handling demand and 7 band 6 nurses to provide clinical triage and lead the rapid response in the localities.
The Initial Response Model
The aim of the new service was to provide a quick, efficient responsive single point of access for urgent requests for help.
The key objectives of the IRT are to offer:
- A 24/7 response to telephone requests of help for urgent mental health needs for people of all ages and conditions
- Triage and routing to appropriate mental health services
- Face to face triage from the Crisis Team within an hour of referral
- Triage and signposting to other local services e.g. using the Sunderland Wellbeing Directory.
A crucial part of the design was to enable the IRT to work alongside and co-exist with the Trust’s Crisis Team. To enable this all staff have interchangeable roles across the IRT and the Crisis Team.
An important aspect of the transformation was to make the crisis service available to users of all ages and conditions. The diagram below shows ICTS
(Initial Crisis and Treatment Service) for children, older people’s service (OPS) and learning disability (LD) teams work closely with working age adults crisis staff so the service is universal across the life span.
The IRT comprises of nurses (band 6) and other roles such as support workers (band 3), which allow the team to focus on the clinical aspects of their work. The telephone hub is located in Sunderland and a band 6 nurse from each locality is based in the hub for each shift.
The IRT has improved access by developing a call handler role undertaken by the band 3 support worker staff to take initial calls, collect demographic information and complete administrative tasks, allowing nurses in the team to focus on the clinical elements of the triage process. Telephone lines have been increased from one to nine and the use of assisted technologies such as digital dictation and 3G tablet computers has helped improve overall efficiency.
The key clinical interventions include:
- Triage through telephone consultation with a nurse to gather information regarding presentation. This results in a clinical decision leading to the most appropriate intervention for the individual
- Rapid response (within one hour) home visit for face to face triage, risk/mental health monitoring, signposting, brief therapeutic interventions, managing distress
- Medication, if needed is accessed through the out of hours GP service to manage presenting symptoms, or signpost to service user’s own GP
- De-escalating distress
- Provision of advice in relation to benefits and other social issues
- Depression mood management, relieving anxiety
- Provision of advice and signposting in relation to substance use.
Outcomes and experience
Very positive responses have been received from service users showing they were happy with the responsiveness and 100% would be happy to recommend the service to a friend. Positive responses have also emerged from carers and GPs that use the service with the speed and appropriateness of responses from the team involved.
“You saved my life! I know I’ve still got a far way to go but I have the determination to fight and get there, so please accept my appreciation and thanks. You do an amazing job!”
“Wonderful support and understanding during a very difficult time. Make sure there is enough funding to keep this very valuable service going.”
Staff working in the service have evaluated the service positively particularly as the redesign of the pathway has released time for clinical staff to focus on clinical care.
Benefits identified since the introduction of the IRT include:
- Increase in number of service users with urgent mental health needs receiving an intervention from the service
- Improved response times for home visits for face to face assessment (average 30 minutes from call to door)
- Reduced avoidable harm – no “bounced referrals” (these are now routed to the most appropriate service)
- Reduction in time spent by ambulance service in relation to service users with urgent mental health needs – IRT team more readily available
- Reduction in breaches of 4hr A&E target relating to service users presenting with mental health problems
Learning from the project includes:
- Engaging and communicating with staff involved at every stage is vital to a smooth change
- Working in collaboration with commissioners has helped the development and wider implementation of the service model. A CQUIN supported testing in year 1 and substantive funding has since enabled wider roll out across the whole of South of Tyne.
- Training staff to undertake tasks – do not assume everyone will know how to operate in the team