NHS North Central London (NCL ICB) plans and pays for a wide range of health and care services in north central London – Barnet, Camden, Enfield, Haringey and Islington. This includes community health services such as physiotherapy, community nursing, podiatry (or foot care), speech and language therapy for example, as well as mental health services, including talking therapies and crisis support.
In 2021, we carried out a detailed review of NHS community and mental health services across north central London to look at what services were being provided in each of the boroughs and whether they met the health needs of our residents.
We undertook data analysis, held workshops and interviews with patient representatives, key stakeholders from local NHS providers, voluntary sector organisations and local authorities to get a greater understanding of existing services. An outline of the key findings and themes from this initial review phase are published in the following baseline reports:
Both reports highlighted the wide variation and complexity of services provided across north central London, with waiting times, availability and access to services differing from borough to borough, often leading to inequity in health outcomes for patients.
The report findings provided us with a case for change and a basis from which to develop our plans to improve community and mental health services across north central London as we develop as an integrated care system.
Addressing variation in service provided, access and experience across the five boroughs and improving health outcomes for our local populations, continues to be a key priority for us.
In line with the vision of the NHS Long Term Plan, our ambition is to move care away from hospitals and closer to people’s homes and communities, placing greater focus on proactive care and preventing ill health. We want to deliver community and mental health services that are more joined up and integrated with GP practices and hospitals, as well as with local authority and voluntary and community sector services.
We are committed to working with our integrated care system partners to improve services and help our residents to stay well and live healthier independent lives.
Core service offer
We undertook extensive engagement with a wide range of stakeholders including service users, carers and residents, clinicians, operational leads and senior leadership from our community and mental health service providers, GPs from primary care, local authority colleagues, voluntary and community sector partners. A series of co-design workshops, Resident Reference Group meetings and numerous working groups and meetings were held with these stakeholders to help us shape and refine what the “core offer” should look like.
The core offer defines the level of service residents can expect to access regardless of which north central London borough they live in. It outlines how a service can be accessed, whether by self-referral or referral from a health professional, and where it will be provided, such as in a community clinic, hospital, care home or patient’s home, for example.
Feedback from patients, carers and residents
The feedback received and insight gained during the initial engagement phase of the programme has been instrumental in helping to shape the core offer and continues to influence the delivery and implementation phase of the programme.
What residents told us and how we have responded:
• Need to improve access to services and reduce waiting times. There are especially long waits for autism assessments for children.
The core offer for each function and service includes service response times, for first and ongoing contact. We have invested additional funding into autism / attention-deficit hyperactivity disorder (ADHD) assessment for children to increase capacity and to help reduce waiting times across north central London.
• A need for greater focus on early intervention and prevention.
The ambition of the community and mental health services programme is to move care away from hospitals and closer to people’s homes and communities, placing greater focus on preventing ill health and supporting residents to stay well.
• Reduce the number of ‘hand offs’’ between organisations through better use of technology so that people avoid having to frequently repeat their stories.
We are currently developing coordinating functions through a series of workshops on early intervention which will incorporate national guidance and best practice. The coordinating functions will support with better direction and signposting for patients and will ensure that those with complex needs can have a single assessment and holistic treatment plan in place.
• A need for more holistic, person-centred care with consideration given to other factors that can impact health, such as housing and environment for example. Residents also indicated wanting greater involvement in decisions about their care.
The agreed core offer supports the personalisation agenda, with more care planning, case management and enhanced patient led decision making, including proactive support for those patients with long term health conditions.
• Services must be culturally competent and sensitive to the needs of our diverse communities.
We are working with our local health service providers to address this through further training and we also want to recruit more local people and use their experience and knowledge to work more effectively with the communities we serve.
• Early transition planning needed to support children and young people to adult services, especially in relation to mental health services to prevent them ‘falling through the gap’.
We have worked with young adults to co-produce a new young adults mental health strategy, building on nationally recognised good practice in our region. The development of a service for young adults aged 16-25 to better support their safe transition from children to adult mental health services remains a key priority area.
• Services need to improve their communications with patients, such as changes to appointments or cancellations and be more responsive to patient queries.
The core offer proposes more services with direct access, therefore reducing the need for GP referral.
• Digital services welcomed by some residents, but there was concern that digital exclusion for others could lead to even greater health inequalities. Services must be responsive to the individual’s preference.
The roll out of ‘virtual wards’ is currently underway which allow patients to be cared for in the comfort of their own home with the use of technology to monitor their health remotely where they and their families agree this is in their best interests.
Delivery and implementation
Our focus now is on the delivery and implementation of the core offer, working with our health and care partners at both a north central London integrated care system level and a borough integrated care partnership level.
Our service providers are leading the delivery planning for both north central London wide and place (or borough) based projects, with particular emphasis on addressing identified gaps in services and ensuring investment is targeted where need is greatest.
For example, in year 1 (2022/23) of the 5-year implementation programme, priority areas have included the following:
- Silver Triage, introduced during 2022, connects ambulance staff to senior clinicians with expertise in geriatric emergency medicine to support the assessment of older people with frailty and ensure they are cared for in the most appropriate healthcare setting. About 80% of calls result in the frail or elderly patient avoiding an unnecessary trip to hospital.
- Roll out of ‘virtual wards’ in progress using remote monitoring technology to provide care for patients in their own homes. Virtual wards can reduce the patient’s risk of unnecessary A&E attendance or admission to hospital, thereby freeing up acute hospital beds for those with more complex health needs.
- Invested £1.8m in an autism hub to address the backlog from the Covid-19 pandemic period, ensuring those waiting the longest are seen as a priority. In addition, we are investing a further £600k per year to increase capacity to meet the rise in demand for autism services in Barnet, Enfield and Haringey.
- Increased recruitment of healthcare professionals to a range of roles in autism / attention deficit hyperactivity disorder (ADHD) services, community nursing and therapy services, thereby improving service capacity to deliver the core service offer.
- Increased investment to address variation in community health services for children with special educational needs or disabilities (SEND), complex or long-term health needs and children looked after and for children and young people with health needs in Barnet, Enfield and Haringey.
- Established a pain management service in Haringey which will take a proactive approach to delivering care, reducing pressure on acute hospital services.
- Expanding the capacity and skill mix of the community nursing service in Enfield to ensure that patients receive the best possible care at home and reducing the need to be admitted to hospital.
Mental health services:
- Transformed community mental health services wrapped around primary care, integrated with social care and voluntary and community sector for patients with a serious mental illness. Roll out of new transformed community core teams to reach 100% of primary care networks (PCNs) in 2022/23.
- Expansion of crisis prevention houses to Barnet, Enfield and Haringey. Crisis cafes / safe havens are now available in each north central London borough, providing a safe space for residents who are at risk of a mental health crisis.
- Implemented a new Home Treatment Team service in Barnet, which provides intensive mental health support for children and young people in their own homes who would otherwise be at risk of admission to a hospital inpatient unit. The service is due to be rolled out to all north central London boroughs during 2023/24.
- Increased provision in Mental Health Support in Schools via mental health teams which support schools, teachers and individual pupils.
- Investment into dialectical behaviour therapy (DBT) services has provided a local service closer to home, replacing the need to refer children and young people to services in South London and Hertfordshire.
- Investment made into specialist and community eating disorder services. Waiting times have now reduced from 10 weeks to 6 weeks. The service provides holistic assessment and co-production of care plans for children, young people and their families.
- Mental health support available from NHS and voluntary and community sector organisations, both face to face and virtually 7 days a week, available in 20+ languages with psychological interventions for people with long term conditions.
Assessing progress and next steps
We will track the progress of implementing the core offer for both community and mental health services to monitor its impact on residents and to demonstrate population health improvement at a borough and system level. This will also support our decision-making and help us to prioritise areas for investment going forwards.
When fully implemented, we believe the core offer will help us to achieve our ambition of addressing the inequity of service access and health outcomes which currently exists across north central London.