Clinical support services

Team: Single Point of Access - Physical Health
Contact: helen.stewartmckaigue@nhs.net ​​​​​

What did we want to achieve?

The ‘Call Before Convey’ initiative was set up between North West Ambulance Service, CWP, and the Countess of Chester Hospital. The initiative aimed to improve patient experience, reduce delays, and prevent overcrowding in A&E by ensuring the patient receives the right care, at the right time, either in the community or through alternative pathways. Within Single Point of Access (SPA), the service had an opportunity to improve the experience of their frailest patients by ensuring they can access the right service, at the right time, as early as possible in their journey.

What we did

The three organisations will be working together to consider alternatives to the Emergency Department (ED). The test of change will initially focus on patients over 65 years of age who are not presenting with life threatening illness or a mental health complaint. North West Ambulance Service (Paramedic) contacts Single Point of Access when they are with a patient and prior to conveying a patient to the emergency department. They discuss the patient with an experienced nurse coordinator who triages the patient and then diverts the patient to either same-day emergency care (SDEC), SDEC frailty, district nurses, or the Hospital at Home Service.

Results

Between 20 January 2025 and 9 February 2025, there were 58 total calls, 36 deflections (62%) and 22 people (38%) were conveyed to the ED.

Themes and learning of the 36 deflections:

• 17 were accepted by Hospital at Home
• 8 were accepted by SDEC Medical
• 6 were accepted by GPs from the Acute Visiting Service
• 3 were accepted to SDEC frailty
• 1 was accepted to SDEC surgical
• 1 was accepted to district nursing

Of the 22 Conveyed to ED, a further 10 could have been cared for in SDEC if it were open (at the time of the pilot, SDEC was not accepting referrals at the weekend). This would have taken the deflection rate to 79%. Seven were conveyed for a non-injurious fall. The average age of those seven people was 85. Five people needed an automated external defibrillator assessment (due to experiencing acute chest pain, shortness of breath, or acute abdominal pain).

Next steps

Over the next 12 months there are plans to expand the age criteria for the Call Before Convey service, to include adults aged 18 and over, along with this an amendment of the Hospital at Home criteria so more referrals can go straight there, avoiding hospital admission all together. SPA is currently driving the utilisation the Hospital at Home service to prevent hospital admission via the Call before Convey initiative. In the long term, between all involved services, they will strive to progress to true integrated care coordination.

Team: CWP Pharmacy, Lead Pharmacist Education and Training, Mersey Care NHS Foundation
Trust (FT), Educational Programme Director, Greater Manchester Mental Health NHS FT,
CMHT Clinical Pharmacist, Pennine Care NHS FT, Rehabilitation Network Pharmacist,
Lancashire and South Cumbria Mental Health NHS FT
Contact: jenny.hulme@nhs.net

What did we want to achieve?

The General Pharmaceutical Council’s (GPhC) new standards for the initial education and training (IET) of pharmacists require increased clinical placement opportunities for undergraduate pharmacy students to practice skills and embed knowledge. Undergraduate pharmacist training has traditionally been a knowledge-led course. New standards require a demonstration of competence across a range of core skills. The assessment uses an established competence and assessment hierarchy known as Miller’s triangle, with many competencies requiring evidence at the ‘does’ level. The group wanted to create a mental health workbook that could be used by any undergraduate pharmacist completing a mental health placement in any organisation.

What we did

This project brought five North West mental health trust pharmacy teams together to co-develop a flexible workbook to support increased access to undergraduate placements - shifting the focus of placements from knowledge to skills to support the new IET. Collaborators explored current opportunities and content of undergraduate mental health placements. They developed a workbook that provided opportunities for students to practice and develop core pharmacy skills to complement taught knowledge, in the context of mental health. The collaborative development of the workbook prompted all North West mental health trusts to re-evaluate their offer for undergraduate placements, supporting development of the future workforce.

Results

A workbook (with versions for students, tutors and model answers) mapped against the Health Education England Core Mental Health Competencies for Pharmacy Professionals, and the newly-published Entrustable Professional Activities, was produced. This provided a range of preparatory activities and a framework for local supervisors to support placement activities. As a coincidental output, a student safety card was developed to allow students to confidentially summarise relevant information for use in a medical emergency whilst on placement. As a result, there has been an increased number of mental health placements available as the workbook can be utilised in any mental health setting.

Next steps

• Evaluate the effectiveness of the undergraduate placements and workbook.
• Review and update the workbook in line with feedback from students and tutors.
• Work with the local schools of pharmacy to increase placement provision for mental health trusts.
• Maximise undergraduate placement provision at CWP, engaging more of the Pharmacy Team.
• Work with the new school of pharmacy at the University of Liverpool to influence the design of future undergraduate placements to ensure parity with acute trusts.
• Continue to collaborate as a North West team to produce material for both undergraduate placements and trainee pharmacists.

Team: Infection Prevention and Control Team
Contact: samantha.weston5@nhs.net

What did we want to achieve?

The aim of the project was to raise awareness of infection prevention and control issues and common infections using an alternative format to the ones traditionally utilised. Information regarding infection control precautions and prevention of illness can sometimes be seen as inaccessible, overly clinical, or mundane. The aim was to try to present important, current and topical information throughout December 2023 in an eye-catching, fun and interactive way, whilst remaining informative and factual.

What we did

It was decided that as the winter season was approaching, the team would utilise the popular ‘Elf on the Shelf’ phenomenon as the basis for the campaign. The team set out identifying key themes that could be included across December and a list was drawn up. Resources were sourced and elves Edwin and Eric ‘joined the team’ on 1 December. A post was shared every day from 1 December to 25 December on both X (formerly Twitter) and the CWP staff Facebook group. Posts included topics such as sepsis, hydration, hand hygiene, cleaning, vaccinations and more!

The elves were involved in a wide range of activities, causing ‘mischief’ across the Trust and beyond, even accompanying the team to external training at Manchester Metropolitan University.

Results

Analysis of the data relating to the number of views, shares and comments was collected from X. For Facebook content, the number of likes and comments was used to indicate the engagement of the post. Overall, the elves gained 15,256 views across both platforms over the course of the month. On average posts on X, had around 600 views a day, with the maximum number of views for a single post peaking at 1,854. Posts on X were shared by several organisations such as The UK Sepsis Trust, Body Positive and Infection Prevention Society, as well as other NHS organisations and infection prevention and control teams. Feedback regarding the project was positive, particularly on the CWP staff Facebook group, with comments such as:

• “These are great - love seeing them every day.”
• “Loving the posts. Superb content.”
• “Absolutely brilliant!”

Next steps

The project was thoroughly enjoyable for the Infection Prevention and Control Team and was well-received on both platforms. The team plans to run the project again in the future and hopes to expand on this, with different topics to focus on. The team also hopes to share more content via the CWP Facebook page, which has over 2,000 members from across the Trust, to help reach staff who may not access emails or be aware of changes in guidance.

Team: ICT Services
Contact: nick.williams@nhs.net

What did we want to achieve?

CWP’s ICT Services led a major two-year project to design, update and upgrade the Trust’s wide-area network (WAN) infrastructure, removing single points of failure and capacity restrictions within the Trust’s infrastructure such as firewalls, internet connections and building resilience. The project also aimed to redesign how traffic flows across the network for improved performance and improved cyber security. There were three key objectives: to replace CWP’s WAN, improve Wi-Fi in inpatient and resource centre locations; and to improve network performance, resilience and security posture.

What we did

• Phase one – Working with BT to scope, install and migrate each of the 35 locations to their new link with minimal impact and downtime.
• Phase two – Configuration of new firewalls and infrastructure. Running the old and new infrastructure in parallel whilst changes are implemented to avoid disruption to services. Wi-Fi coverage surveys and improvements to inpatient locations.
• Phase three – Final infrastructure changes to migrate from old infrastructure to new without service interruption. Migration of the Trust to the new FortiClient VPN. Completion of Wi-Fi surveys for coverage at resource centres.

Results

• Thirty-five CWP sites were migrated with a minimum bandwidth increase over their previous WAN link of 900%. Bandwidth out to the internet increased by 200%.
• Sites no longer reach maximum capacity following security updates allowing users to continue working without impact.
• Each site now has independent access to services located within the Health and Social Care Network (HSNC) such as clinical applications or on the Internet. HSCN network bandwidth increased by 100%.
• Improving access to SystmOne and EMIS and resilience for business continuity as staff can still access critical systems from a different CWP location.
• The project has removed four medium-to-high risks from the ICT Services risk register subsequently improving the overall cyber security position of the Trust.
• Removed network single point of failure at 1829 data centre.
• Firewalls are now hosted in two high availability data centres by BT.
• Wi-Fi is now installed into 74 CWP locations, provided by a resilient wireless controller pair.
• New armoured covers for wireless access points (WAP) have been installed, which allows for the location of wireless access points in optimal locations on wards where coverage could not be provided previously, whilst maintaining patient safety.
• Commissioned Wi-Fi coverage surveys across all CWP inpatient and resource centre locations, and remediated coverage issues where possible.
• New VPN solution for remote access (FortiClient) to support increasing agile workforce accessing the network remotely. FortiClient improves the security of CWP devices with vulnerability scanning, web security and content filtering.

Next steps

The plan is to expand on the new infrastructure to further improve CWP’s cyber security posture. The new infrastructure allows CWP to support new technologies to be implemented in the future, such as cloud telephony.

Team: Wirral Children and Young People’s Mental Health Service Access Team
Contact: clare.williams60@nhs.net  

What we wanted to achieve

Waiting lists for Children and Young People Mental Health Services (CYPMHS) are growing nationally and worldwide. Consequently, there was a need to understand how referred children and young people on CWP’s waiting list could be better supported and assessed in a timely manner.
 
The CYPMHS Access Team have an open referral process for professionals, parents and self-referrals for young people aged 16 years plus, with easy access on the MyMind website. All referrals are triaged within 24 hours and any specialist referrals are sent across to core teams such as the Learning Disability team, Eating Disorder Team and 0-5 Team. The objectives were to:

• reduce waiting times, minimising delays by optimising resources and streamlining the referral pathway
• improve access to support to ensure children, young people and families receive timely mental health assessment of need
• improve relations with community agencies to ensure children and young people have access to the right service at the right time

What we did

The team recognised that they needed to solely focus on the waiting list. They paused all of their other duties to concentrate on the national four week wait list strategy. They reviewed admin processes to help to support staff and streamline the assessment pathway. The team focused on linking in with CWP’s third sector agencies to become more accessible, having the opportunity to work collaboratively to best support children, young people and families with moderate to severe mental health difficulties.

Results

Waiting times from referral to access to initial assessment have significantly improved in the last two years, with both average and longest waits to reduce by over 50%. Average wait in 2022 was 20 weeks, with 256 young people waiting, whilst average wait now is three weeks with an ongoing improving trajectory, and only just over 100 young people waiting. This has enabled the team to triage referrals with 24 hours, offer a comprehensive mental health assessment, with a safety plan and next steps for children, young people and families.

Next steps

Current modelling demonstrates that if referral rates remain static, there is capacity and resilience within the access team to sustain this trajectory for initial assessment and be compliant with the pending four-week national wait.

There is also scope to start developing the breadth of the role to include more systemic consultation and enhanced formulations.

Team: Wirral Children and Young People’s Mental Health Service Access Team
Contact: clare.williams60@nhs.net  

What we wanted to achieve

Waiting lists for Children and Young People Mental Health Services (CYPMHS) are growing nationally and worldwide. Consequently, there was a need to understand how referred children and young people on CWP’s waiting list could be better supported and assessed in a timely manner.
 
The CYPMHS Access Team have an open referral process for professionals, parents and self-referrals for young people aged 16 years plus, with easy access on the MyMind website. All referrals are triaged within 24 hours and any specialist referrals are sent across to core teams such as the Learning Disability team, Eating Disorder Team and 0-5 Team. The objectives were to:

• reduce waiting times, minimising delays by optimising resources and streamlining the referral pathway
• improve access to support to ensure children, young people and families receive timely mental health assessment of need
• improve relations with community agencies to ensure children and young people have access to the right service at the right time

What we did

The team recognised that they needed to solely focus on the waiting list. They paused all of their other duties to concentrate on the national four week wait list strategy. They reviewed admin processes to help to support staff and streamline the assessment pathway. The team focused on linking in with CWP’s third sector agencies to become more accessible, having the opportunity to work collaboratively to best support children, young people and families with moderate to severe mental health difficulties.

Results

Waiting times from referral to access to initial assessment have significantly improved in the last two years, with both average and longest waits to reduce by over 50%. Average wait in 2022 was 20 weeks, with 256 young people waiting, whilst average wait now is three weeks with an ongoing improving trajectory, and only just over 100 young people waiting. This has enabled the team to triage referrals with 24 hours, offer a comprehensive mental health assessment, with a safety plan and next steps for children, young people and families.

Next steps

Current modelling demonstrates that if referral rates remain static, there is capacity and resilience within the access team to sustain this trajectory for initial assessment and be compliant with the pending four-week national wait.

There is also scope to start developing the breadth of the role to include more systemic consultation and enhanced formulations.