Manchester Mental Health & Social Care Trust

An integrated, multi-professional psychiatric emergency care system to achieve compliance

Overview

Emergency services in Manchester for psychiatry were fragmented and demonstrated many of the problems that Hospital at Night and Taking Care 24:7 were designed to solve. Manchester Mental Health and Social Care Trust developed a new, integrated psychiatric emergency care system called PEARL (Psychiatric Emergency, Assessment, and Referral & Liaison).

The PEARL service brings together the most urgent aspects of crisis resolution and enhanced support and assessment for those attending A&E. The service is configured to have four experienced professionals working 24 hours a day, seven days a week as the core of the emergency response team. This team is multidisciplinary with nurses, occupational therapists, psychologists and social workers included to work in a fully integrated way with medical staff support. The PEARL service is planned to start in the second quarter of 2007.

Organisational background

Manchester has a population of over 450,000 and is served by three psychiatric hospitals. Each is attached to one of the three acute trusts in Manchester which each have an Accident & Emergency department. The Manchester Mental Health and Social Care Trust is responsible for psychiatry services in the whole of Manchester - which has an urban population characterised by exceptionally high psychosocial deprivation.

The service aspects of the change are part of an agreed development for the city and there is already committed funding for the major structural changes required, including permanent staff costs and estates costs.

Challenges

Psychiatric emergency services in Manchester were based around three medical on-call teams. EWTD compliance could be achieved by combining existing rotas and work patterns. However, this compliance was at the cost of doctors’ working shifts with relatively low workloads and poor educational opportunities. It would also lead to pressured day time hours with difficulty in providing specialised training in psychological skills, audit skills, research and management. The PEARL project provided junior medical staff with explicit educational support from consultants and other professionals built into the model of working, and allowed a much clearer path for achieving competency in emergency psychiatric care.

Specific objectives of the pilot

Specific objectives of this project are:

• To apply the principles of Hospital at Night reconfiguration and workforce redesign for the first time to an integrated mental health economy. The work will focus on a mental health trust in a major conurbation with severe social deprivation
• The development of the new service (PEARL) will achieve functional separation between integrated emergency/crisis care and non-emergency care
• To improve educational opportunities for doctors in training who will have periods of experiencing emergency services distinct from training periods within the various non-emergency services
• To increase the ability of doctors in training to develop defined skills assessed using a competency-based system that will link to the development of the competency framework to be adopted through the roll-out of MMC into Mental Health.

Delivering compliance

This pilot will:

• Be a unique emergency mental health service, which will offer clear opportunities for benchmarking across the wider NHS
• Allow the learning and dissemination to be available in time to use the learning in other mental health trusts in achieving WTD 2009 compliance.

The pilot commenced in February 2007 and finished in October 2008.