Improving access to A&E care for people with mental health conditions

Evolving Communities worked with Gloucestershire County Council and Healthwatch Gloucestershire to evaluate the experience of people who had accessed mental health support through the A&E departments at Gloucestershire Royal Hospital and Cheltenham General Hospital.

Parity of esteem for mental health and physical health services

As part of NHS England’s Five Year Forward View, the 2018 budget announced a commitment to achieving parity of esteem between mental health and physical health services. Funding for NHS mental health services is set to grow over five years, with a £250 million a year investment focusing on providing 24/7 crisis services, including comprehensive mental health support in every A&E department.

Several emergency departments now have a mental health liaison team for at least part of the day, and many have introduced additional training for staff to ensure that patients with mental health issues/conditions receive the best care.

A patient presenting to Emergency Department with either a physical or mental health need should have access to Emergency Department staff that understand and can address their condition, and access to appropriate specialist services, regardless of their postcode, GP or time of arrival. (The Core Principle of Mental Health in the Emergency Department, The Royal College of Emergency Medicine).

Mental health A&E care in Gloucestershire

Gloucestershire County Council asked Healthwatch Gloucestershire to find out more about the experiences of those who access mental health support through the A&E departments at Gloucestershire Royal Hospital and Cheltenham General Hospital.  Healthwatch Gloucestershire asked Evolving Communities Consultancy to carry out a short exploratory evaluation to gain an initial picture of how well the needs of those accessing mental health support through A&E were being served.

Our work

We looked at the experience of those who had accessed the hospital emergency departments with or for a mental health issue over the past year.  Over a three-month period, we spoke with patients and their families and carers. Due to the sensitive nature of the evaluation, we mainly used one-to-one interviews (face-to-face and telephone) and an online survey. We also spoke with emergency department staff and relevant external stakeholders such as, service providers within the voluntary and community sector.

Our findings were presented with recommendations for development and improvement, to help Gloucestershire Health and Care NHS Foundation Trust and Gloucestershire Hospitals NHS Foundation Trust respond to the issues raised. We also shared our report with other organisations and services that are involved in crisis mental health care in Gloucestershire.

Read the report

Supporting hospital patients to return home earlier and to live independently

Evolving Communities worked with Wiltshire Council and Wiltshire NHS CCG to evaluate the effectiveness of Home First, a new initiative that aimed to facilitate early discharge of patients aged 65+. We worked with the client to hold focus groups, attended meetings and gathered feedback from patients, relatives, staff and other stakeholders.

Better Care Fund

The Better Care Fund is a programme spanning the NHS and local government.  It seeks to join-up health and care services, so that people are better able to manage their own health and wellbeing and live independently in their communities for as long as possible.

Delayed Transfers of Care

One of the areas where the Better Care Fund is typically used is to provide initiatives that aim to reduce the numbers of delayed transfers of care (DTOC).  Transferring medically fit patients out of inpatient care to their own home in a timely fashion can be challenging to the healthcare system.  Although deemed medically fit by the medical team, older patients may continue to have mobility issues, social issues and may also still require assistance with the activities of daily living.  Despite this, they do not need, and often do not wish to remain in an acute hospital bed.

Home First initiative

Wiltshire Council and Wiltshire NHS CCG are committed to reducing the number of delayed transfers of care.  They also saw the benefit of helping people to become as independent as possible, thereby decreasing the intensity of their ongoing package of care.

They were supported by the Better Care Fund to establish Home First – a new initiative that aimed to facilitate the early discharge of medically fit patients aged over 65 to their own home.  Rehabilitation workers and therapists were employed to support people for up to 10 days after discharge from hospital.  Patients were able to come home earlier while still receiving care and support, and this also allowed more time for longer-term packages of care to be put in place.

Our work

We evaluated the effectiveness of the Home First service from the point of view of patients, relatives, staff, and stakeholders.  Over a four-month period, we gathered and analysed people’s experiences and views of using or providing the service.

We held focus groups, attended multi-disciplinary team meetings, visited local support groups, conducted one-to-one interviews, and ran an online survey, giving all of those who took part many ways to engage with the evaluation.  Our report presented findings and made evidence-based recommendations.  System leaders valued the deeper insight into the initiative and made plans to incorporate our recommendations into future development plans.