Independent investigation into the care and treatment of AB

To review the non-urgent pathway of care between the GP, MINT, IAPT et al, by considering a) the non-urgent waiting times for MINT services, and b) accessibility to MINT services Commenced April 2022. With all of the CQC 'Should Dos' completed and 4 of the 7 CQC 'Must Dos' completed. The remaining Must Do actions, are all in motion and progressing well. MINT Services: - specifically good progress towards improved triaging and Single Point of Access services, resulting in better directing of individuals into appropriate care pathways; improved joint working between Primary Care Level - IAPT and Secondary Mental Health services within the MINT model (allowing increased number of touch points and interfacing); system and process in place to enable to identify individuals who have fallen off waiting lists/ follow-ups. Improved interface meetings between services now address threshold concerns. We have increased monitoring of incidents and related information related to MINT to identify areas for further review. The Trust has engaged RW Health, a consultancy firm with expertise in process improvement & business information, to improve the timeliness of referral to treatment commencing. The work streams include: • Stratification of risk & complexity • Managing unplanned care – improving our existing provision for patients contacting the service for support through an acute exacerbation of their condition. Increasing the speed of response and ensuring short term therapeutic interventions are linked into their long term care plan. • increase the proportion of patients who receive a clinical risk assessment, with 70% now having one in place and further work ongoing to improve the quality of safety plans to empower the patient to take action during acute exacerbations of their condition. Long term action plan to sustainable which started in April 2022, which will be completed - closely monitored by CQC and commissioners. The last progress report was provided to the CQC in October 2023.

To deliver the ongoing CQC MINT Action Plan, with specific focus on: Recruitment and Retention; Operational Delivery; Digital Improvement; Risk Mitigation and Referral To Treatment Pathways. The action is aligned directly with the ongoing transformation work taking place in partnership with system partners, including local authority. Commenced April 2022. With all of the CQC 'Should Dos' completed and 4 of the 7 CQC 'Must Dos' completed. The remaining Must Do actions, are all in motion and progressing well . Specific progress already made on referral to treatment and quality improvement; electronic patient records and recording; and managing complex referrals. SystmOne Flags have been developed to expedite triage, assessment and prioritise intervention. This has enabled the service to have a more rigorous, assertive and pro-active case management system for users with complex or higher risk presentations. We have also updated relevant dashboards and trackers; Improved data capture on medical record systems and databases; Amended operational processes; Aligned MINT Operational Policy across teams; Reviewed DNA Policy / SOP; and Improved process to assess patient’s appointment needs; along with Follow Up processes improvement. We have achieved an increased flow through services, allowing access to a wider range of community-based services and support. The electronic patient record systems allow improved visibility of our performance, including case loads and waiting times. We have increased our MINT workforce from a baseline of 200 WTE in July 2022 to 300 WTE in October 2023. We have also recruited to key staff including a dedicated Associate Director for MINT, Lead Nurse for Quality and Safety, and new Head of Performance. We have also fully recruited to all Band 7 Mental Health Acute Response Service roles - 100% of Primary Care Networks. Work is underway to develop pathways for Complex Emotional Needs and review the role and activity within Complex Psychosis / Rehabilitation pathways. Recovery and Wellbeing College was relaunched and is now accepting self-referrals.

The implementation of a robust mechanism, created collaboratively with West London NHS Trust colleagues to support social workers and multiter managers with evidence based threshold application and inclusive planning for vulnerable children where primary carers have presenting mental health diagnoses or acute concerns about their emotional well-being. This pilot post will sit within Ealing's MASH, be referred to as the Designated MASH Metal Health Advisor, and go-live in August 2022 to bolster our holistic thinking about supporting vulnerable primary carers with mental health presentations. Completed: August 2022 ESS were mentioned in the trust Loop newsletter; article 'Pilot of Mental Health Advisor role is proving a success' in the December 12th, 2022 issue. Furthermore, the mental health advisor pilot was highlighted as innovative and forward-thinking during our recent Ofsted Focused Visit in November 2022 inspection. In one case, the mental health advisor was able to provide information that resulted in the issuance of a court order to protect a vulnerable child. This is a positive example of the impact of the MASH Mental Health Advisor role. The MASH Mental Health Advisor has also provided training to social workers and multi-agency partners on how to identify and respond to mental health concerns in primary carers. This training has been well-received and has helped to improve the confidence of staff in communicating concerns. The MASH Mental Health Advisor has also developed a new protocol for information sharing between ESS and WLT. This protocol has been implemented and is now business as usual. The Independent Chair from Ealing Safeguarding Board has acknowledged that there has been positive improvements in multi-agency working through the Multi Agency Safeguarding Hub forums.