The Initial Response Service
for Sunderland and South of Tyne
Improving access and how this fits in to the
objectives of the Crisis Care Concordat,
providing emergency and urgent care.
Helen Pike – Community Clinical Manager for Access and
CRHT services
Rachael Winter- Clinical Lead CRHT Sunderland
Overview
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Context
IRS Model Development
IRS Evaluation/ Outcomes
Other key services key to the Concordat
The Service Model Review
Request for Help
Information & Advice
Initial Response
Initial evaluation regarding nature, risk, complexity and urgency of the problem
More Intensive Packages of Care
Hospital
Signposting to principal service pathway for assessment and formulation
Psychiatric Intensive Care
Treatment Intensity
Low Security
Specialist Ward
Crisis Beds
PICU
Environment
Acute Ward
Intermediate
In the Community
Low Security
beds
Intermediate Facility
Challenging
Crisis Bed
Behaviour
Acute Ward
Mild severe
non psychotic
Very
severe &
complex
nonpsychotic
Psychosis
Dementia
Assessment
Intensive Home
Treatment
At Home
Intensive
Home
Home
Etc.
Challenging
Behaviour
Treatment
Assessment Formulation
& Treatment Planning
Crisis Assessment
Discharge
Neuro disability
Learning
Disability
Children &
Young
People
Substance
Misuse
Scaffolding
Medium Security
Access Phase 1: The case for change
Sunderland was chosen as the 1st location for the development of a new
urgent access model following discussions with service users, carers, GPs
and commissioners.
Like a lot of areas there were:
•Problems getting through to Crisis Team by phone as Triage saturated++
•Overnight and at peak demand times callers could wait hours for a return
call from a clinician
•No ready point of access for Older People or People with a significant
Learning Disability seeking Urgent Advice/ Intervention
•Fewer than 35% of referrals needed a admission/ home treatment
•Most of the non-crisis referrals required advice/ signposting but at low risk/
acuity
Engagement
• Large scale events- Local Authority, GP’s,
Commissioners, Service Users
• Focussed Group Events- Service Users,
GP’s, Staff, 3rd sector.
• Series of design workshops
• Ongoing engagement through and after
implementation
Initial Response Service
South of Tyne and Wear
Information
Collection & Routing
Gateshead
Rapid
11
Response
Nurses
Triage & Action
South Tyneside
REQUEST
FOR
HELP
GH UCT
ICTS
Home Based
Treatment
Assessment
LD
Gatekeeping
ST UCT
Home Based
Treatment
Rapid
11
Response
Nurses
Triage & Action
Sunderland
ROUTING
ICTS
OPS
Assessment
LD
Gatekeeping
SL UCT
Home Based
Treatment
Rapid
11
Response
Nurses
Triage & Action
OPS
ICTS
OPS
Assessment
LD
Gatekeeping
Phase 1: The Model
•IRS to offer 24/7 Universal telephone access for requests for urgent help.
•No restrictions on who could refer
•Triage and Routing over the phone- (Mental Health and other local
Services)
•Face to Face Triage (Rapid Response) if clear plan cannot be determined
over the phone
•Seven Band 6 Nurses for Telephone and Rapid Response
•Five Band 3 Nurses for call handling and Rapid Response
•Use of digital dictation and 3G laptops for clinical documentation
•Flexible interchangeable roles and rotation between Crisis Team and IRT
roles dependant on demand.
Phase 1: Benefits of IRS
• Quick and efficient responses to requests for help
• Effective routing to the correct services in and out of NTW
• Flexible and collaborative working systems implemented
• Reduction of clinician administration burden, and freeing time to care
(mainly through adoption of mobile digital dictation)
• Improving personal and clinical outcomes for people in crisis with mental
ill health by reducing admissions/ MHA detentions, improving patient
safety and patient experience
Evaluation-IRS in numbers
Typical weekly activity
•1500+ Incoming telephone calls
•1000 Total Contacts
•400
Home-based Treatment contacts
•50
Crisis Assessments
•100
Rapid Responses
…and growing
•90% calls answered within 15 seconds
•>98% within 3 minutes (Average=9 Seconds)
•>80% rapid responses achieved in under one hour
IRS Referrals (Q3 2013)
Other includes:
• Self Harm Team
• Acute Care Trust
• NTW Inpatient Ward
• Ambulance
• Consultant Psychiatrist
• Residential Care Facility
• Drug and Alcohol Services
• IAPT
• Member of Public
• EDT
• Probation
Service Feedback
Service User and Carer
GP
The service is
responsive and friendly
I felt listened to and
was delighted
Fantastic – a huge
improvement!!
You should have
done it before
Staff
More manageable
A lot happier
Skills are valued
Spend more time
I cannot imagine where I
would be today if you had not
been there for me.
I couldn’t
have got this
far without
your help
You do an
amazing job!
You listened
and told me
what to do
Keep this very valuable
service going
You are all very dedicated,
patient, compassionate
people
Wonderful support!
Impact on acute bed-usage
Smoothed bed day rate (per 10,000 18-64 pop)
Bed day rate (per 10,000 18-64 pop)
260
240
220
North of Tyne
200
South of Tyne
180
NTW
160
Launch of IRSSouth only
140
Oct-Dec
2012
JanMar
2013
Apr-Jun Jul-Sept Oct-Dec
2013 2013
2013
JanMar
2014
Apr-Jun Jul-Sept
2014 2014
Phase 2 IRS Model
UCT
IRS
Urgent
Home Based
Treatment
Rapid
Response
11
Nurses
Triage & Action
Single
Point of
Referral
ICTS
OPS
Assessment
Gatekeeping
LD
Triage
Team
Noncomplex
Clinical
Diary
Routine
Complex
Huddle
Clinical
Diary
Other Key Services in Sunderland:
• High spec (RAID-esque) Psychiatric Liaison
Team (Jan 2014)
• Street Triage (from Sept 2014)
• Court and Custody Diversion (2013)
• Transformation of Community Pathways (PCPlate 2014)
• Home treatment alternatives for patients with
LD/ OPS service needs- ongoing
• Extended Hours Urgent-Care Consultant
Working- (Nov-2014)
Summary
• IRS developed in a context of shared goals with
commissioner and wider partners
• IRS shown to vastly improve access & responsiveness
with widely positive feedback
• Crisis Care and Access cannot be improved by oneservice alone- needs a networked- collaborative
response