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North West London New Model of Care Project (NMOC) – improving inpatient mental health care for children and young people

Published online by Cambridge University Press:  18 June 2021

Jovanka Tolmac*
Affiliation:
Consultant Child and Adolescent Psychiatrist, Harrow CAMHS, Central and North West London NHS Foundation Trust
Alun Lewis
Affiliation:
NMOC Project manager, West London NHS Trust
Azer Mohammed
Affiliation:
Consultant Child and Adolescent Psychiatrist, Westminster CAMHS, Central and North West London NHS Foundation Trust
Elizabeth Fellow-Smith
Affiliation:
Consultant Child and Adolescent Psychiatrist, West London NHS Trust
Johan Redelinghuys
Affiliation:
CAMHS Clinical Director, West London Trust
Braulio Girelas
Affiliation:
Clinical Research Fellow, Centre for Psychiatry, Imperial College, Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College, Honorary Spr, Harrow CAMHS, Central and North West London NHS Foundation Trust
*
*corresponding author.
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Abstract

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Aims

Specialised inpatient mental health services for children and young people are commissioned and managed by NHS England (NHSE) and provided by NHS as well as independent sector. The access to beds has been managed nationally with young people admitted far from home. There were capacity issues identified in London. To address these concerns, NHSE invited organisations to work in partnership to co-design and establish new models of care. This is one of the first of such projects, set up to manage the budget for children and young people's beds on behalf of NHSE and change the way of managing and monitoring admissions.

Our aims:

To reduce length of inpatient stay

To enable admission of young people as close to home as possible

To improve resource efficiency, capacity and capability of managing young people in crisis in the community.

Method

A number of changes were introduced, including engagement of community and inpatient clinical staff, repatriation to units closer to home and introduction of CRAFT meetings (early review meetings in inpatient units to enable timely and effective discharge planning and support back to local services). The implementation has been closely monitored by the project manager and clinical group, which included representatives from all organisations involved.

Result

After four years, young people are admitted to hospitals closer to home and the length of inpatient stay has decreased by 18%. The number of admissions has decreased by 28%. Out of area occupied beds days have been decreased by 66%.

Significant recurrent budget savings have been achieved. Over the past three years, these savings have been reinvested in developing crisis community support and more specialist community services within CNWL and West London Trust.

Conclusion

There have been considerable benefits of multiple organisations working in partnership to improve patients care. The success of the project has created further opportunities for the development of services which provide safe and effective alternatives to admission (such as crisis services, home treatment teams and specialized community services). In summary, this collaborative model has improved the quality of care and experience for young people and reduced the need for psychiatric admission.

Type
Quality Improvement
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists
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