Network NameNetwork Name

Developing a

mental health

Intensive

Support Team

Network Name

Problems before IST• DTOC, LOS, high bed occupancy• People had to be admitted if needing intensive

support• Generic intermediate care did not accept

people with MH problems• CMHT had limited capacity for intensive

interventions• Too many people admitted to long term care

unnecessarily

Network Name

Small steps• 2008 - in one locality – small MDT ‘discharge’

team from existing resources• Supported early discharge• Reduced LOS and bed usage• Released ward staff• Built MDT Intermediate Support Team• 2009 - rolled out Network wide – ‘discharge’

teams Intermediate Support Teams

• 2013 – commissioned: extended to 7 day / 8-8

Network Name

Aims• To prevent admission to MH wards• To facilitate timely discharge from MH ward• To facilitate discharge from acute hospital• To prevent crises escalation in community• To prevent premature admission to long term

care• To facilitate discharge from care home back to

own community dwelling

Network Name

Lancashire-wide roll out• Co-ordinated approach and considerable amount

of work undertaken to reduce LOS in inpatient wards, particularly targeting stays over 150 days

• IST roll-out was managed end 2009 with very little additional money – small numbers of staff focussed initially on LOS / ward discharges

• This allowed bed closures and release of staff into IST and gradual build-up of broader IST roles

Network Name

What helped• Outcome Data + evaluation• Flexibility and responsiveness• Recovery approach and personalised care• All professions in one team• Ability to visit up to 3 times a day• Team caseload and team risk taking• Seamless hand over to other services• IST gate-keeping all potential admissions to

MH ward• Co-work cases with other teams as required

Network Name

Network Name

One team’s evaluation• IST admitted 29 people during 2012 after

intervention = 80% success rate in prevention• 94% success at facilitating discharge (very few

readmissions - none within 28 days)• 76% success at preventing admissions to long

term care• 71% success at preventing step up in level of

care provided• 97% sustainable 2 months after closure

Network Name

Impact – Reduced Length of Stay

Network Name

• 5 teams at different levels of resourcing and at different stages of development

• 1403 people referred across Lancashire during 2012• Reduced re-admission rates (currently well under the

5% national target) • Achieved average LOS under 35 in July 2012 – currently

average 55-60 - impacted by CCG funding delays and increased acuity

• A reduction in the numbers of occupied dementia beds across the network from 76 in March 2009 to 40 in Feb 2013

Impact across Lancashire