On 1 October 2019, mental health and learning disability services in North Cumbria previously delivered by Cumbria Partnership NHS Foundation Trust (CPFT) were transferred to Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW), then known as Northumberland, Tyne and Wear NHS Foundation Trust (NTW).
The aim of this transfer was to provide mental health and learning disability services in North Cumbria with greater support from the expertise of CNTW, a large specialist mental health and disability trust rated ‘Outstanding’ by the CQC. The transfer was a year and a half in the making, with many staff from CPFT and CNTW working closely together throughout that period to make the transition as smooth and effective as possible.
Reflecting on the first year following the transfer, CNTW’s Chief Executive John Lawlor said: “Our services across the North East and North Cumbria have learned so much from each other, embracing innovative approaches and exploring new ways of working.
“We are pleased that fewer patients are now having to travel out of North Cumbria to receive inpatient care, and waiting times for busy services such as our Children and Adolescent Mental Health Service have improved, with some services such as our Children’s Learning Disability and Behaviour Support Services having no waiting lists at all.
“Together we have worked towards the aim of improving the outcomes and quality of mental health and learning disability services for local communities in North Cumbria and, despite the COVID-19 pandemic posing huge challenges for us all over the past six months, we are proud of the progress that has been made by the teams. Our teams are motivated and will continue to strive to provide the best possible quality of care to communities in North Cumbria.”
Several significant changes to services have been implemented so far this year. The mental health Crisis Team in North Cumbria now operates ‘open referrals,’ meaning that anyone in distress can call the team and ask for support without a referral from a medical professional. That Crisis Team is also now a ‘universal’ service, meaning there is one straightforward Freephone number to call – 0800 652 2865 – for anyone in distress from young children to older adults.
Staff working in the area’s various Learning Disability inpatient units have formed a new staff ‘peer support’ group, coming together to continually share things they have learned, best practices and to support each other through challenging situations. Inpatient staff in Cumbria have also linked up with the multi-disciplinary team of staff at Mitford Unit, a specialist autism inpatient unit run by CNTW located in Northumberland, to share good work and support them with clinical decisions.
The trust is also developing an improved ‘urgent care pathway’ that enables each person to be seen by the right clinician, in the right place, in a timely manner. North Cumbria’s Crisis Assessment and Home Treatment Teams are now available 24/7, which has made a huge difference to this.
From the outset the trust’s leadership focused on the importance of integrating with and support the rest of the health and care system in Cumbria to ensure that mental and physical health services are joined up and patients receive seamless care. That has proven to be especially important this year in the face of a global pandemic. David Muir, Group Director for the North Cumbria Locality at CNTW, said: “We have developed close relationships across our communities and are working closely with organisations such as Healthwatch and the Cumbria Council for Voluntary Service. We are members of the community forums across the north of the county, and are building links with GPs and Integrated Care Communities.
“One excellent example of this work has been our Older Adults’ Mental Health Team proactively supporting care homes in the region, not only working with patients and care home residents but also supporting care home staff to maintain their resilience and psychological wellbeing as lockdown and the stresses of the pandemic has a significant impact on care homes.”
In July the trust established a regular Patient and Carer Involvement and Experience Group in North Cumbria. David Muir explained, “Involving the people who use our services, and their families and carers, is incredibly important to us at CNTW, and we are actively engaging with patients, carers and families across the North Cumbria region to listen to how we can serve them better.
“These Involvement and Experience Groups, already embedded in our localities in the North East, are a vital part of CNTW’s efforts to ensure that the trust works together with the people who use our services to continually improve care.”
The groups are open to patients, service users, and their carers as well as trust staff. They ensure that the Locality has effective systems and processes in place to meaningfully listen to and respond to feedback from patients and carers, and to identify themes, issues and areas of good practice which can be shared and addressed across the trust. For now the groups are meeting virtually via video conference, to ensure safety and adhere to COVID-19 restrictions.
One person who attended the Cumbrian group’s first session commented, “I believe this will be beneficial – you are continuously reviewing changes and trying to involve family members, carers and service users in their own care … [which] could make a substantial difference to an individual’s mental health journey.” Another added, “CNTW’s involvement opportunities are long-term, brilliant, non-tokenistic and welcomed.” (For more information about how to attend the group, please contact firstname.lastname@example.org.)
Two Involvement Facilitators are leading the work across the North Cumbria region to ensure people are involved at every level of their care, and they will soon be joined by eight Peer Supporters. The role of Peer Supporter was created by CNTW to improve the support that patients and carers receive in their services. Peer Supporters draw upon their own experiences of mental ill-health to offer guidance, compassion and hope to the people they work with.
The resilience of all NHS services has been tested during the COVID-19 pandemic, and CNTW’s services in North Cumbria were no exception. David Muir said: “We have had to find new virtual ways of working, and have continued to effectively support and treat many people throughout this year using remote telephone or video-call technology.
“Feedback from patients and from the clinicians using the technology has been good and we will continue to refine and develop this way of working. This means we are now able to offer people a greater choice of consultation and treatment options to suit their needs. We know the importance of face-to-face, in-person contact for many of our service users living in the community, and most of our teams have been able to return to offering this to those who prefer it using the appropriate PPE and safety precautions.”
Jon Rush, chair of NHS North Cumbria Clinical Commissioning Group (CCG), said: “This was a significant change for us and we are proud of the staff who have embraced this change. We are very pleased to see improvements to areas we knew were challenged, such as waiting times in CAMHS and a reduction in patients travelling out of county for inpatient care.
“It is really encouraging to see work developing with the community and third sector around wellbeing and recovery.
“No one could have foreseen the impact of COVID-19, and the teams have worked brilliantly to support patients over that time; we look forward to seeing those improvements continue.”