MaST supporting Community Mental Health Teams (#3228)

Creation
Draft
Initial
Detailed
Accepted
Adoption
Idea Description
Supplementary Information
Innovation 'Elevator Pitch':
MaST is a powerful easy to use dashboard, which uses predictive analytics to generate insights to support staff making decisions about safe and effective mental health care
Overview of Innovation:
MaST is a simple web based dashboard, underpinned by predictive analytics, which uses risk and complexity profiling across a caseload to enable planning decisions and allocation of resources to be made based on the needs of populations and cohorts of individuals.
MaST draws on data from clinical systems, primarily from the electronic patient record (EPR) but can also incorporate data from other systems where available.

MaST has been adopted by community mental health teams across Mersey Care NHS Foundation Trust and is currently being deployed by two further NHS trusts to track and manage team and individual caseloads. MaST enables decisions about allocation of resources and raises awareness of the patient flow through services. It is an effective approach to enable care providers to take action, initiate interventions, and close care gaps.

MaST is used as a focal source of information for staff during supervision, as part of the multi-disciplinary team meetings and supporting care co-ordinators on a daily basis by giving a single view of their caseload and helping them to manage their KPIs (eg care plan, physical health checks, CPA review)

Risk of Crises Algorithm
The Risk of Crisis algorithm forms the core of the MaST Solution. The algorithm is used to estimate the likelihood of a service user going into crisis, and this enables the stratification of a caseload of service users based on risk of using crisis services.

Used in practice, MaST enables team leaders and staff members to make informed judgments about managing their caseloads, such as focusing greater attention towards those at higher risk of crisis, and potentially considering discharge options for those with very low risk of crisis.

OHS evaluate the effectiveness of the algorithm and review the algorithm performance on a monthly basis. The Risk of Crisis analysis shows what proportion of crises occur in a given proportion of service users (“observations”) when ranked based on decreasing likelihood of crisis, as estimated by the risk algorithm.
OHS have tested the algorithm performance with four different data sets including working in partnership with National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC) using their Clinical Record Interactive Search (CRIS).
Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
Similar Content3
Innovation 'Elevator Pitch':
This is a risk stratification model that aims to predict and prevent crisis by segmenting the mental health patient population by risk and likelihood of an acute mental health crisis.
 
Overview of Innovation:
Currently, the response to mental health crisis is mostly reactive. To address the increasing pressures faced by the urgent care services by patients presenting with mental health crisis, prevention and early intervention must be prioritised. This will not only alleviate pressure of several emergency care services but will also improve patients’ prospect by ensuring  timely interventions that avoid patients’ mental health deteriorating further.

The Rapid, Assessment, Interface and Discharge Plus project, in partnership with Telefonica Alpha, aims to achieve this by developing and validating a risk stratification model and algorithm to predict mental health crises. The risk stratification model will use four years of pseudonymised clinical and sociodemographic data to capture potentially robust predictors from a wide range of sources to provide an overall indication of a patient’s risk of experiencing a mental health crisis.

By applying the model onto the Trust’s mental health population, we can stratify the patients into different risk groups and subsequently target the highest risk segment of the population for preventative early intervention with improved accuracy. This information will be provided to clinicians who will determine the necessary measures required to prevent the progression from high-risk status to actual mental health crisis. This will act as a ‘clinical support tool’ for clinicians in making their decision and does not replace the clinicians decision on how to manage patients.

The project will look at how the risk stratification model can be implemented into practice, working with Community Mental Health Teams (CMHTs) to pilot the model. The model will be refined, tested and validated by a team of data analysts, clinicians and to embed it into systems for routine clinical care. Using this tool can help improve patient care by avoiding unnecessary admission, presentation at A&E, or potentially prevent an escalation in the worsening of a patient’s mental health state.
 
Stage of Development:
Trial stage - Trial stage to prove that the idea actually works as intended
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Long term conditions: a whole system, person-centred approach / Wellness and prevention of illness / Digital health / Innovation and adoption
Benefit to NHS:
In a pressurised financial environment, faced continually with greater challenges to meet quality objectives, this innovative product can simultaneously improve patient outcome by reducing intensity and/or preventing mental health crisis as well as reduce costs by stopping the over saturation of emergency services.
 
The use of technology systems and data is at the centre of the NHS Five Year Forward View. It highlights how the use of data and technology will transform outcomes for patients and citizens. The insights derived from the risk stratification model will help the NHS explore how the information/ data they hold could be used in clinical settings to benefit patients. It will highlight patterns in the data that can be used to develop proactive preventative measures to support mental health patients.  The ability to stratify risk and predict those who might be at risk of mental health supports frontline mental health clinicians to de-escalate situations before crises arise. This leads to improved patient outcomes by avoiding the further deteriorating on mental health and potential saving where the intervention has prevented an entry to the crisis care system.
 
The reduction in demand for emergency and inpatient mental health services will relieve the pressure from the crisis care pathways resulting in enhanced patient experiences, improved staff support and morale, and greater efficiency and effectiveness within urgent care mental health services to respond to current and future patient needs.
 
Initial Review Rating
1.00 (1 ratings)
Benefit to WM population:
Mental health crisis is a significant and increasing problem across Birmingham and Solihull. The number of crises in the region has increased by an average of 7% year on year for the past 5 years and is projected to increase further in the future, according to the Midlands and Lancashire CSU. Therefore, this places increased level of pressure on urgent care services and it is important to be able to introduce proactive measures to stop at risk patients from going into crisis.

The redesign of the crisis care pathway is a key NHS England target for CCGs and a central theme within the STPs. Within the Birmingham and Solihull STP, one of the key mental health objectives is to ‘Manage – preventing mental health crises and managing them better when they do’. Identification of at risk patients and supporting them by intervening sooner fall in line with the STP objective and while this tool doesn’t directly prevent the onset of crisis, it helps refine predictions and manage at risk patients proactively. The use of data-informed decision making leads to better clinical outcomes for West Midlands patients and can potentially release both capacity and resources across the emergency and urgent care system
Current and planned activity: 
The risk stratification model was developed collaboratively between BSMHFT and Telefonica Alpha as part of the Rapid, Assessment, Interface and Discharge Plus NHS Test Bed. The pilot work testing is being supported by The Health Foundation.
 
The tool is planned to be tested in real time by Community Mental Health Teams (CMHTs) in Birmingham and Solihull from September 2018. The CMHTs were identified to be in the most suitable position to be able to utilise a predictive model for crisis presentation into their working practice. The patients at risk will be flagged in real time and this will be reviewed by the CMHTs and an effective intervention put in place to avert the crisis. A robust evaluation is being conducted by the CSU looking at the effectiveness of the tool in supporting clinician’s decision making.
Return on Investment (£ Value): 
N/A
Return on Investment (Timescale): 
N/A
Ease of scalability: 
3
Read more
Hide details
Innovation 'Elevator Pitch':
The bespoke training programme aims to increase mental health awareness and increase skills in identifying and managing mental health crisis with emphases to referral pathways that can be applied in operational practice by frontline professionals.
 
Overview of Innovation:
Rapid, Assessment, Interface and Discharge Plus takes a more localised training approach and has identified priority front line services that frequently coming into contact with those suffering from mental illness and potentially at risk of crisis i.e. Police officers and Community healthcare professionals who are working with individuals with both physical and mental health difficulties.

The training aims to increase knowledge and understanding of mental illnesses as well as support early referral and appropriate management of individuals who are experiencing deterioration in their mental health. The overall aim is to build confidence and competence in front line professionals and generate a supportive and informed approach when working with those in mental health distress.

The training modules are as follows:
  • Understanding mental illness: Signs and Symptoms of mental health
  • Effective de-escalation and communication skills
  • Understanding Mental Health Act (1983) and Mental Capacity Act (2005)
  • Crisis Prevention and Management (including risk assessment of suicide and self-harm)
  • Dementia
The training package offers provision to tailor elements of the content to suit the locality’s policy and services available, should organisations wish to implement the  training. For example, the 'Crisis Prevention and Management' module explores referral pathways and services available within Birmingham and Solihull Mental Health Trust. These could be easily amended to reflect the organisations services to ensure the training maintains its bespoke, localised approach. The training can be customised but would generally take a full day to cover all modules.

This allows for local frontline professionals that come in contact with mental health patients to be able to identify and prevent patients going into crisis by referring patients to access appropriate mental health support in a timely manner.

The training is delivered by a registered mental health professional to ensure that the full potential of learning amongst participants is achieved. The experience and understanding of such an individual will aid questions posed throughout the training and allows them to draw to from previous experiences/scenarios from real life mental health practice within the delivery.
 
Stage of Development:
Close to market - Prototype near completion and final form may require additional validation/evaluation and all CE marking and regulatory requirements are in place
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Education, training and future workforce / Innovation and adoption
Benefit to NHS:
National directives indicate that, in general, the public should have a baseline knowledge and understanding of mental illness (Public Health England, NHS Five Year Forward View). It is nationally acknowledged that many patients with long term physical health care conditions have a diagnosed mental health issue (NHSE FYFV). Due to limited training and data sharing the co-ordination of care for these patients is often fragmented (Crisis Concordat, 2015). This may result in patients experiencing mental health crisis and entering the urgent care pathway unexpectedly. This causes pressure on urgent care services and could also impact the patient experience.

Our vision is to help develop a community healthcare workforce that is fully trained in mental health, with access to the right tools and pathways to support patients suffering with mental health issues. This will ensure that patients with comorbid conditions are positively supported to access the right care, at the right time in the right place. The better management of the mental health care can have a positive impact to patients' care as well as possibly avoiding their mental health deteriorating further.

In 2015 the Mental Health Network Confederation highlighted; "the police and mental health providers need to understand each other’s legal powers, roles and responsibilities "to manage /reduce the risks associated with mental health crisis". Additionally, the police often come in contact with people experiencing mental health distress and usually have to manage difficult and complex situations. Training is needed to equip them to recognise and assist when someone has a mental health issue or learning/intellectual disability. This is in line with the College of Policing requirements for mental health awareness training within the police force.

The police are frequently in contact with people suffering from mental health problems, so to be able to identify these symptoms and be able to direct them to right pathway in a timely manner is a huge benefit as it can save the person further unnecessary complications and faster access to help. The police would also benefit by being able to correctly manage people undergoing mental health distress when responding to mental health-related incidents. They will be able to acquire practical skills to spot the triggers and signs of mental health issues and be able to confidently step in, reassure and support a person in distress.
  
 
Initial Review Rating
1.00 (1 ratings)
Benefit to WM population:
Within the West Midlands 20-40% of police time is dedicated to those experiencing mental health difficulties. Therefore, the ability to identify symptoms and signs of mental health distress and be able to refer patients to the appropriate pathways ensures a better and efficient system. The training helps police develop skills to manage those with mental health illness/facing mental health crisis and saves time and resources. The training will cover the Mental Health Legislation and Mental Capacity Act which aligns with the College of Policing training requirement for the West Midlands Police.

By training the Birmingham Community Healthcare Trust staff, this supports staff being able to ensure the patients with long terms conditions that have signs of mental health issues are supported to access the right care in a timely manner. Having an understanding of the mental health support pathways and services for patients avoids patients experiencing mental health crisis by early intervention and reduces unplanned emergency visits to the urgent care system.

There is wider scope however for target audiences and suggestions to be considered for future delivery of the training include:
  • Wider community and health care teams within Birmingham/ Solihull
  • Schools, universities and colleges
  • Ambulance services
  • Fire Services
  • Workplace learning and team building
Current and planned activity: 
To date, the RAIDPlus training package has been created and delivered by the mental health trainer who is a registered mental health nurse with a number of years’ experience within acute mental health. The training was delivered to 1600 staff across the West Midlands Police and 150 Birmingham Community Healthcare staff.  

The police training was tailored and aligned to the learning objectives of West Midlands Police. This is in connection to the College of Policing requirements and Authorised Professional Practice for mental health within the police force. The community trust training was tailored to meet the learning needs of staff to capture the referral pathways and crisis prevention elements relevant to their services. Overall, the training was positively received by staff and early outcomes suggest improved capacity to provide supporting interventions to reduce the risk of crisis.
What is the intellectual property status of your innovation?:
BSMHFT is the provider of this training package.
Return on Investment (£ Value): 
medium
Return on Investment (Timescale): 
N/A
Ease of scalability: 
2
Read more
Hide details
Innovation 'Elevator Pitch':
Integrate with PAS and rostering systems, to bring together capacity and demand; automating manual processes used to judge which staff ought to be scheduled to which patient appointments with dynamic rescheduling throughout the day via mobile app.
Overview of Innovation:
NHS community services are one of the last industries to adopt an automated and intelligent appointment scheduling system to help manage their field based (community healthcare) staff. Significant improvements can be made in the way community workforce are managed by optimising the patient appointment booking (scheduling) process.

Initial research indicates that there are few Trust with systems in place to effectively and efficiently schedule which staff should visit which patients at which times. Our objective is to work with NHS Community Trusts to develop MISS (Malinko Intelligent Scheduling System) to systemise the current informal and ad-hoc processes used to do this.

Malinko is a scheduling system with mobile app to allow staff to check in and out of visits which is already used in other sectors.  It requires some additional work to ensure that it works well for the healthcare sector.  These elements are:
  • Integration with the PAS (Patient Administration System) to bring in patient appointment requirements and with the rostering system to for staff capacity.  By taking this information, along with predefined parameters based on provided KPIs, Malinko’s scheduling algorithm will ensure that the rostered staff attend the optimal visits.
  • Mobile app to enable staff to communicate live back to the main system any issues that would result in their visits to require rescheduling that day. The Malinko system would then automatically reschedule these and let any affected staff know. 
  • The office staff have a live nurse tracker board, enabling them to see last known locations of all nurses out in the field.
  • The nurse can send a text message or voice message to the patient to let them know they were on their way to avoid DNAs (Did Not Attends).
This would enable substantial productivity gains and cost reductions within NHS community services with marked reductions in non-clinical contact time as Nurses on average spend 19% time in administration includes office visits. It would also result in significant service improvements being achieved as it would allow community nurses to both spend more valuable time with patients and enable them to see more patients.  In turn, we would expect to see a reduction in acute activity and pressures.  Additionally, by optimising the appointment booking process there is an opportunity for NHS Community services to make direct cost savings in area’s such as travel, administration, staffing and the costs associated with DNAs.

Stage of Development:
Evaluation stage - Representative model or prototype system developed and can be effectively evaluated
WMAHSN priorities and themes addressed: 
Mental Health: recovery, crisis and prevention / Digital health / Innovation and adoption
Benefit to NHS:
Integration with the PAS and the staff rostering system into the MISS to intelligently create the appointment schedules has a whole range of benefits for the NHS provider and patients.  In summary:
  • Improve caseload management using skills, knowledge and training to best effect.
  • Help release and focus capacity due to ‘live’ organisation wide view of demand and capacity.
  • Reduces time in morning meetings at start of day as these can be electronically received by staff.
  • Automatically scheduling based on an algorithm, reducing staff scheduling time and leaving them to just approve and make manual alterations to this schedule.  
  • As referrals come in during the day, they are automatically added and scheduled dependent upon priority.  If they require a visit within the day, the system will automatically add the job onto the most efficient round and dynamically reschedule other appointments effected.
  • Route optimisation, reducing time spent travelling and cost of travel.
  • Automatic mileage expense claims based on these routes.
  • Release time to care improving patient and staff experience.
  • Patient feedback mechanism to report satisfaction with the service.
  • Analysis of patient/community nurse combinations - eg where a patient dislikes a particular nurse and so is regularly out for their visits
  • Ability to send telephone and text alerts to patients reducing likelihood of DNA and leading to improved timeliness of visits including administration of medicines. This will also result in giving patient a narrower window of likely nurse arrival.
  • Ensure prioritisation of patients that need to be seen today and those that can be deferred.
  • Ability to redirect workforce to high risk patients in an emergency, therefore preventing admissions.
  • Ability to provide continuity of care as system logs number of previous visit during allocation process.
  • Benchmarking performance across the team members or indeed whether the team as a whole is underperforming against an external benchmark with full visit history for each patient and by each staff member. Spot trends and improve resourcing.  Examples include identifying where a patient doesn’t like a particular nurse and so is regularly out for their visits, or to quickly identify training needs where staff are regularly underperforming for particular types of visits.
  • Lone worker risks prevented with mobile app and nurse tracker board.  Silent panic alarm button within the app can send to office or escalate to emergency services.
Initial Review Rating
4.20 (1 ratings)
Benefit to WM population:
MISS can help the NHS to deliver better care at a lower cost by freeing up capacity to meet ever increasing demand.
 
Based on in-depth research on site with 4 NHS Trusts, West Midlands NHS Community Service providers can reduce the following by deploying the MISS:
 
Reduce senior nursing non-clinical contact time: It is forecast a service/locality with 20 FTE staff, with one locality manager and two senior triage nurses, could reduce 109 hrs/month of senior nursing non-clinical contact time by automating the patient allocation process with MISS (3.6 hrs per day of senior nursing time 7 days per week; service running at 50% at capacity the weekend).
 
Reduce Community Nursing/HCA non-clinical contact time: It is forecast a service/locality with 20 FTE staff and 16 community nurses/HCAs could reduce 416 hrs/month of non-clinical contact time (1 hour a day per nurse - 7days a week; service running at 50% capacity at the weekend).
 
Reduce DNA rates by 50%: Although one Trust we have worked with reported a DNA rate of 10%, we have little hard data with regard to current DNA rates and the cost of each DNA to the Trust, the view is DNA rates could be significantly reduced by adopting MISS’s integrated automated patient appointment reminder system (text and voice calls). Other NHS Trusts have analysed how much each DNA costs, reporting an average of £80 per DNA. Reducing DNAs would also have a significant impact on improving the efficiency of the service/locality and reducing patient complaints.
 
Other potential cost savings include (more detailed analysis required): Overtime; Bank and Agency; Travel; DNA; Replace incumbent standalone lone worker system in two of the Trusts; Replace current standalone expenses system; Admin.
Current and planned activity: 
Nov 15: 1st NHS customer 

Nov 16: Agreement from GM NHS Trust to deploy MISS in their District Nursing service across 6 localities and their District Nursing evening service, pilot funded by the GMAHSN Momentum bid. 

Dec 16: Other pilot start; deploy MISS in their District Nursing service in two localities.

There are a number of other NHS organisations who are interested in MISS.  We are looking for further pilots or early adopter profile Trusts, which due to recent funding we are able to part fund internally.

We would like introductions to (Deputy) CIO or (Deputy) DOF roles within West Midlands and nationwide to NHS Trusts which provide community services, including mental health.
What is the intellectual property status of your innovation?:
The IP is held within Liquid Bronze.
Accredited with Information Governance
Accredited with ISO27001
Return on Investment (£ Value): 
high
Return on Investment (Timescale): 
2 years
Ease of scalability: 
Simple
Read more
Hide details
0
0
Votes
-99999

Created by

Share and Follow