Herefordshire Primary Care Trust - Stonebow Unit
A specialist approach for mental health transfers
If you live in Herefordshire and need to be admitted to a psychiatric hospital either as an in-patient or as a day patient a doctor will arrange for you to go to the Stonebow unit, a specialist mixed gender centre staffed by doctors, nurses and other support staff providing 24 hour care to people with acute mental health crises.
In early 2009, the Herefordshire Primary Care Trust tendered the non-emergency patient transport service and the wide-ranging contract provides transport to all community hospitals and treatment units throughout the county, including the Stonebow Unit. The overall tender specification did not specify the individual units/hospital/treatment requirements, and individual requirements would need to be identified by any supplier undertaking this new contract.
The Stonebow Unit has two inpatient wards and any supplier would need to provide transport for admissions, inter-hospital transfers and discharges, as well as transport to their day care unit for outpatient care. In all the contractor would need to complete over 160 patient journeys a month.
Patients receiving day care are often on weeklong courses of treatment or therapy and it is most important that all sessions be attended for a consistent treatment programme.
Mental health patients require different care than those receiving treatment for medical or physical conditions, and these patients are often paranoid, unpredictable, unreliable, aggressive, addicted to substances and have complex personal circumstances. Any provider would therefore need to demonstrate a robust safeguarding policy for both these vulnerable individuals and the staff taking care of them.
The main challenge that the unit faces is ensuring that the service is accessible to its users and has a policy for ensuring patients can access the service. This type of patient has a higher than average non attendance rate for treatment and care due to their condition , so patient transport providers would need to ensure that it maintained this level of availability and accessibility.
Patients attending the Stonebow Unit come from throughout Herefordshire and the Shropshire / Herefordshire borders, and any provider would need to be able to show depth of operation to meet this need.
NSL Care Services identified during the tender process that local knowledge was the key differentiator for ensuring that service could be delivered and maintained during critical handover periods. The omission of a detailed specification for each site within the overall Herefordshire tender document could have created a risk for the PCT. However NSL Care Services have huge experience in the transport of vulnerable patients, and from experience we know that within general service delivery specifications there will be critical areas of care that needed addressing . Our solution sought to identify these quickly and react accordingly.
The Stonebow Unit quickly became an area of service delivery that NSL Care Services identified as:-
• critical to the PCT
• creating a large proportion of PCT activity
• requiring a specialised service, as mental health patients have different needs to patients that are receiving treatment for medical/physical conditions
• one that needed more than the typical non-emergency patient transport service provided to hospitals.
To ensure that we could address the key areas of service delivery for this part of the contract our solution sought to appoint a local contract manager. By appointing someone with experience working at the hospital, we were immediately able to gain an in-depth understanding of the service needs, and what needed to be addressed and prioritised. Critically, the appointee would provide the local knowledge, stakeholder management and an understanding of the current operation to ensure a smooth transition to the NSL Care Services team.
We used our extensive knowledge of providing a service to mental health patients in Shropshire as a benchmark to ensure that we were able to meet the needs of the patients of Herefordshire. This knowledge informed us that the services to Stonebow needed to be consistent and reliable; as stability helps, the patients become reassured in the service and more likely to attend and maintain their treatment.
When transporting vulnerable adults such a mental health patients it is most important to have a robust Safeguarding Policy in place. NSL Care Services solution however goes further by providing comprehensive training in this subject to ensure that our driving staff have the necessary skills and confidence to undertake this very specialist area of patient transport. In order to ensure that we completely met the needs of the Stonebow unit we undertook to write the Safeguarding Policy with Herefordshire PCT’s full involvement to ensure it fully met their needs.
Due to the complexities of the patient and their needs, our solution sought to deploy fully trained drivers specifically for this service. We knew that by providing the same driver, this would further reassure the patients, and encourage them to enter and maintain the treatment programmes they need to attend. And the breadth of NSL Care Services operation allowed it to comfortably cover all parts of Herefordshire.
As part of the service being provided to the PCT as a whole, NSL Care Services was awarded the contract in early 2009 and we have been providing a transport service to the unit since the beginning of the contract in May 2009.
We completed a review of the service in November 2010, 18 months after the contract started.
The feedback received from the managers at Stonebow was extremely positive. They particularly liked the fact that the same driver is used; they consider that it encourages patients to complete treatment programmes. The drivers have also become an integral part of the patients’ treatment; they have been able to undertake handovers with the clinical staff and provide information to the clinical teams that would not necessarily become known to them. By using the same driver, it really has helped minimise the number of abortive journeys.
The drivers are also able to feedback directly to the clinical teams the reasons why the patient would not travel, thus providing important information that is used by the Clinical Teams to make decisions about future treatment programmes, communicate with the patients directly and react to information being given.
The service NSL Care Services provides is tailor made to the unit, even though it forms part of a much larger contract, ensuring its individual needs are met and its patients receive the very best service.