Council Leader and Chief Executive meeting

9 July 2020

9 July 2020

1 Contents

• Context and Covid-19 current position

• Changes to services to ensure safety

• Strengthening borough relationships

• How do we work together most effectively on this?

• Appendix A: Changes in detail by site

• Appendix B: Out of Hospital and mental health summary priorities

2 Context and Covid 19 current position

NHS Context

• NHS policy is that areas will work as a single ICS (Integrated Care System) • This includes health and local authority health related services • There will be one CCG to support each ICS • There is a move away from the commissioner/provider split within health care • Borough based partnerships for the provision of care are a key building block for the ICS • The challenge for systems is that there is no legislation directing these changes • As an ICS we are establishing a Partnership Board with LA CEO, DASS and Director of Public Health membership • Our proposal is that this LA Leaders’ meeting is a formal part of our governance, meeting every 1-2 months, ensuring accountability, debate, development of ideas and transparency. • Wherever possible, decisions about care delivery will be taken at Borough-level, supported by the ICS setting strategic context, sharing best practice and undertaking assurance • Our focus will be directed by our joint work to reduce inequalities experienced by our residents

4 Transitional ICS Structure 20/21, during Pandemic

5 We continue to actively manage and monitor Covid admissions to our hospitals

• The total number of suspected / confirmed COVID-19 patients admitted to NWL providers has reduced since April and there is a continued low level of admissions through May & June. Although a small increase in week which is being monitored. Our main focus is on restoring services and encouraging people to use, these whilst actively managing within a Covid environment

Elective care • In April 2020 there were 52,655 people in NW London waiting for surgery for over 18 weeks. This compares to 22,667 a year earlier. An increase of 130% Diagnostics • Prior to COVID 99.5% of patients were seen within 6 weeks. • In April 2020 62% waited more than 6 weeks. Endoscopy • We need 7500 hours of appointments to treat everyone waiting for an endoscopy. • By the end of the year we estimate this will have grown to over 17500 hours of appointments. • We need to increase endoscopy capacity by 130% to see all these patients, given the reduced number we can now scope per session.

We are actively developing and implementing plans to treat these patients. Working as a system to maximise the use of our resources. We are also sourcing additional modular facilities and will maximise our use of private sector capacity. However, staffing is our limiting factor.

7 Demand for urgent care is increasing but is below expected levels, an active programme of support is in place for care homes

A&E attendances • For June 2020 A&E attendances in NW London were 54,808 compared to 94,106; this is a 42% reduction • Some will have sort treatment elsewhere eg from GPs, changes in life style will have impacted admissions (improvement in air quality, change in leisre activities) however, it is clear that others are not yet comfortable in attending hospitals for urgent care needs

Mental health Referrals to crisis teams for adults (figure1) and CYP (figure 2) have been increasing overall in June and referrals to Liaison Psychiatry Teams have increased from mid-April (4 week av. 40).

Support to care homes • Clinical teams have been supporting care homes through a series of visits. 107/140 care homes for older people have been visited in phase 1 (41 declined) • Phase 2 (commenced 22 June): to date 64/148 Learning Disability and Mental Health care homes have been contacted and 34 visited • During the pandemic over 3500 residents were tested – local arrangements are now in place • 1492 staff were tested from 14 March -5 May 2020 through the Wembley centre – local arrangements are now in place • All CQC registered care homes have received infection prevention and control training • Testing arrangements for all discharged from hospital to home care have been agreed.

8 Therefore the NHS continues to operate in a level 4 pandemic emergency as we plan our recovery - restoring services whilst safely managing Covid

• Our priority is keeping patients and staff safe while delivering high quality, equitable services. • We need to keep patients who we know, or suspect, have Covid-19 separate from those who we know do not. We are working as a single system across NW London to create Covid-protected sites and/or Covid protected areas within sites. • Waiting times for planned services have grown significantly. We are urgently starting to deliver all non-emergency elective services that have been suspended since the start of the outbreak. • Patients are not accessing NHS services because they are afraid they may catch the virus in hospitals, A&E and urgent treatment centre waiting rooms. 40-70% are declining to come in for procedures. • We are organising our services differently whilst we are still dealing with the pandemic and we estimate that our services will be 40% less productive than before. • We want to address the increase in inequalities caused by Covid. • We are making some changes to our services – driven by best clinical practice, ensuring patient safety

9 Changes to services to ensure safety Reviewing service changes

• We recognise that we made changes to services quickly; this was necessary to keep patients and staff safe • Other service changes are still being developed in order to treat the maximum number of patients safely • All changes will be regularly reviewed as we go forward, however, we are unable to commit to a timescale for restoring usual services • Some changes can now be reversed eg routine appointments have restarted; however, we anticipate that some of these new arrangements will need to be in place for up to 2 years. • We will be able to consider restoration when: • We have treated the backlog of patients waiting for screening, diagnostics, outpatients, endoscopy and surgery • The infection rate is negligible • We have an effective vaccination • In some circumstances we may see improved outcomes from these new ways of working and we will want to engage with you as to how we embed the changes • We commit to being transparent and discussing these with you as we continue to respond to the emerging situation

11

• We commit to being transparent and discussing these with you as we continue to respond to the emerging situation

Temporary changes we have made in recent months to ensure safe services Acute hospitals

Area of change Why did it change Current status

Suspension of overnight services: Under regular review and challenge as part of • Surgery at Ealing Hospital • Staff shortages and staff redeployed the planning for return to business as usual. • Western Eye Hospital A&E Plan in place to for staggered restart following Diagnostics suspended during Covid -19 to: approval of covid /non covid pathways. - cope with emergencies and cancer Will add capacity through mobile scanners, Suspension of routine diagnostics. cases only. independent sector and development of - Due to reduction in staffing numbers community hubs. who were affected with Covid-19.

• Staff redeployed to support Covid • Routine referral: reopened 22/6 inpatient activity. • Virtual appointments in place (phone & video). Suspension of routine outpatients and • Social distancing and reduction of risk • Urgent physical appointments only elective services . for patients / staff. • Elective surgery: restarting across all • NOTE: 2WW and Urgent activity was provider for clinically prioritised patients. maintained

Children’s ambulatory care at Clinical safety and to allow staff Under regular review and challenge as part of open for clinical redeployment the planning for return to business as usual. referral only. Elective care suspended. Urgent care Elective care commencing centred at Chelsea Paediatric surgery focussed at Chelsea and focussed at Chelsea and Westminster to and Westminster. Under regular review and Westminster free capacity needed for pandemic challenge as part of the planning for return to response. business as usual. Full detail by hospital is provided in Appendix A

12 Temporary changes we have made in recent months to ensure safe services Urgent and primary care

Area of change Why did it change Current status

Temporary closure of Hammersmith UTC Soho Walk-in Centre Pinn Walk-in Centre The number of people attending reduced and St Charles Urgent Care Centre the move to telephone triage meant walk in No plan to change at this time. Under regular Mount Vernon MIU centres not right care setting. review and challenge, Staff redeployed to support the Covid-19 Parsons Green Walk-in Centre is by booking response. only

Screening programmes now restarting and Guidance to prioritise highest risk groups recovery plans in place to address backlog Suspension of screening services however diagnostic and follow up capacity and resume business as usual constrained Recovery programmes in place throughout June, July and August to address backlog

13

Temporary changes we have made in recent months to ensure safe services Mental health

Area of change Why did it change Current status Gradual reopening is taking place. CNWL and WLT consolidated beds onto a

reduced number of sites to maintain safe staffing • Oaktree Older Adults Unit now has 8 older and level of service at the remaining inpatient adult beds. Vincent Square - currently open to units, emergency hubs and other critical 8 patients (from 15) to allow for social services. Patients who continue to require distancing. Day patient and assertive inpatient care have been transferred to the other Consolidation of inpatient community outreach in operation. Trust inpatient units. units • Under 12s Unit - Service now open to

inpatients. Limited admissions to manage Closures include Gordon Hospital, Park Royal social distancing. Day school and assertive Hospital; Oaktree Older Adults Ward, Vincent outreach in operation. Square and Cassel Hospital (Eating Disorder);

under 12s unit; St Bernards (Ealing); Meridan All temporary closures under regular review and Ward (Hammersmith & Fulham Unit). challenge Mental Health Emergency Centres and Hubs are in operation at:

• Lakeside MHU Mental Health Emergency Centres and Hubs • Hammersmith and Fulham MHU were established in both the CNWL and WLT Development of improved • Northwick Park (incl. for CAMHS) footprints to help provide appropriate crisis care mental health emergency • St Charles for mental health patients and reduce pressure care pathways • Riverside on acute A&Es. • St Bernard’s Wolsey Wing

It is proposed that these remain open for 6 months to enable a full evaluation and decision on way forward.

14 We are urgently planning to restart planned, elective care. However, the need for segregation, means that we need to think differently about how we provide safe care

Peer review assurance visits have been undertaken to approve the re starting of planned services • The sites are reviewed as Covid risk free when screened patients do not mix with non-screened patients and there are no emergency patients. Mount Vernon is our only risk free site. We are working to bring Hammersmith and Central Middlesex to this classification. • Covid risk sites see all patients but have been reorganised so that emergency patients are separated from screened patients. In a few, covid screened patients may mix with non-screened at the entrance to the site. • Staff working in Covid free areas are screened every 2 weeks Assessed

In addition, our clinicians and health care providers across NW London are working together to increase the amount of surgery we can undertake safely. We are working to: • Optimise segregation of elective and non-elective. • Consolidate high volume, low complexity surgery. • Optimise patient outcomes by co-locating our complex work • Bring in additional capacity in modular buildings • Maximise use of private sector capacity • These plans are in development and the exact impact on services is not yet known, we will actively work with you over the coming weeks as our plans develop.

15 Strengthening borough-based relationships Creating a single CCG for NW London

• We are working in a national context where each ICS will have a single CCG and where health is moving away from a commissioning/provider split • Although there is a need to reduce CCG management costs, in creating a single CCG we are not proposing to merge borough teams, each borough will continue to have its own CCG team • However, senior leadership will come from an Out of Hospital Director, providing a single health voice across health providers and commissioners in each borough • We believe that local joint commissioning between health and local authorities supports integrated provision and this should be strengthened

17 Strengthening borough-based relationships across NW London

• Through the COVID-19 crisis NWL boroughs have consistently demonstrated the benefit of working in partnership, focussed around the common issue of best supporting residents through the crisis. • Real commitment to build on this joint approach – wherever possible decisions about care delivery should be taken at borough-level • Requires a strong partnership of providers at borough level for implementation and delivery • Needs to be co-designed by Local Authority and health leaders • Interim proposal - for each borough we have 3 NHS leads – primary care, community care and mental health. • One of these leads will assume overall responsibility as Out of Hospital Director • The Out of Hospital Director will: • Have local understanding and knowledge • Build strong local relationships • Work jointly with the Local Authority lead to develop integrated care provision for local residents • A lead for acute services will also link in with the borough team • Local CCG staff will work on behalf of this quartet developing strong, integrated borough-based care Borough Leadership team Health Community Mental Local authority GP CCG lead lead health lead lead Single out of hospital director

18 How do we work together most effectively on this? How do we work together most effectively on this?

20 Appendix A: Changes in detail by site Temporary changes we have made in recent months to ensure safe services Acute Hospitals – Imperial College Healthcare NHS Trust

Area of change Why did it change Current status / plan for restoration of services

As part of our recovery plan for Paediatric Sleep Studies - Fully Closed Clinical staff repurposed to deliver COVID response returning to BAU

COVID-19. The number of people attending the clinics has reduced dramatically over recent weeks in line with Government guidance and IVF, Infertility and Recurrent As part of our recovery plan for people avoiding social contact. Staff will be redeployed to support the Miscarriage Clinic - Fully Closed returning to BAU COVID-19 response, providing clinical support and care for our most vulnerable patients.

Non-essential service stood down in line with Government guidance As part of our recovery plan for Imaging Research - Fully Closed and people avoiding social contact returning to BAU

As part of our recovery plan for Chest & Allergy Clinic - Fully Closed Clinical staff repurposed to delivery COVID response returning to BAU

Adult Sleep Centre at CHX - Fully As part of our recovery plan for Clinical staff repurposed to deliver COVID response Closed returning to BAU

22 Temporary changes we have made in recent months to ensure safe services Acute Hospitals – Imperial College Healthcare NHS Trust (continued)

Area of change Why did it change Current status / plan for restoration of services

COVID-19. The number of people attending the clinics has reduced dramatically over recent weeks in line with Government guidance and Bowel Cancer Screening Programme - As part of our recovery plan for people avoiding social contact. Staff will be redeployed to support the Fully Closed returning to BAU COVID-19 response, providing clinical support and care for our most vulnerable patients.

COVID-19. Consolidation of services to one site. The number of people attending the clinics has reduced dramatically over recent Endoscopy Service at CHX & SMH - As part of our recovery plan for weeks in line with Government guidance and people avoiding social Consolidated with HH Service returning to BAU contact. Staff will be redeployed to support the COVID-19 response, providing clinical support and care for our most vulnerable patients.

COVID 19 - Consolidation of services to one site. High proportion of Renal Outpatients at SMH - As part of our recovery plan for patients are within the Shielding cohort; this has been closed in line Consolidated with HH Service returning to BAU with government guidance and people avoiding social contact.

23 Temporary changes we have made in recent months to ensure safe services Acute Hospitals – Imperial College Healthcare NHS Trust (continued)

Area of change Why did it change Current status / plan for restoration of services

COVID-19. The number of people attending the clinics has reduced dramatically over recent weeks in line with Government guidance and Tri-Borough Ophthalmology - Fully As part of our recovery plan for people avoiding social contact. Staff will be redeployed to support the Closed returning to BAU COVID-19 response, providing clinical support and care for our most vulnerable patients.

COVID-19. The number of people attending the clinics has reduced dramatically over recent weeks in line with Government guidance and Breast Screening at CHX - Fully As part of our recovery plan for people avoiding social contact. Staff will be redeployed to support the Closed returning to BAU COVID-19 response, providing clinical support and care for our most vulnerable patients.

COVID-19. Consolidation of existing service to one site to support the redeployment of clinical staff to support the critical care response Neurosurgery at CHX - Planned As part of our recovery plan for across the Trust and to care for our most vulnerable patients. To Consolidation with SMH Facility returning to BAU maintain a safe level of staffing for the unit due to staff absence (both sickness/isolation and redeployment)

24 Temporary changes we have made in recent months to ensure safe services Acute Hospitals – Imperial College Healthcare NHS Trust (continued)

Area of change Why did it change Current status / plan for restoration of services

COVID-19. The number of people attending the centre has reduced dramatically over recent weeks in line with Government guidance and people avoiding social contact. Staff will be redeployed to support the David Harvey Unit (HH) - Closed to COVID-19 response, providing clinical support and care for our most As part of our recovery plan for walk-ins and self-referrals vulnerable patients. All self-referrals will be directed to the UCC at St returning to BAU Mary's Hospital. To maintain support and healthcare provision for the community, the David Harvey Unit will operate telephone support for GPs, Health Visitors and Community Midwives during the crisis.

Plans to revert back to a 24 A&E department is operating reduced opening hours from 08:00 to hour eye casualty service 20:30 as part of the response to the coronavirus outbreak which is following the return of trainees Western Eye Hospital - Overnight affecting NHS services. If urgent treatment outside of these times is and nursing staff to the service closure required then patients are to attend the A&E departments at St who have been redeployed to Mary’s Hospital or for a telephone support Critical Care, A&E and assessment with the Ophthalmology Consultant on call. wards on the Charing Cross and St Marys hospital sites.

25 Temporary changes we have made in recent months to ensure safe services Acute Hospitals – London North West University Healthcare NHS Trust Area of change Why did it change Current status / plan for restoration of services

COVID-19. Staff shortages, including intensivists and Ealing Hospital - overnight surgery - As part of the planning for anaesthetists. Surgical triage available 24/7 to identify patients Suspension of service return to business as usual requiring transfer to NPH.

Across NW London, it is planned that critical Increasing critical care capacity is in line with supporting care capacity will increase on all sites. emergency activity, specialist services and consolidation of London North West will work in a networked elective activity. model across all sites with Northwick park as the hub matching emergency activity Changes to the ITU baseline capacity at Ealing Hospital is in demand. Ealing hospital will have 18 critical care beds – 6 intensive care and 12 high order to provide a level of critical care that supports the front dependency (previously 6 intensive care and door. Critical care beds are flexed according to demands of 3 high dependency) In both scenarios beds patients. can be used flexibly as required. Temporary changes we have made in recent months to ensure safe services Acute Hospitals - ICHT & LNWUH (joint) Area of change Why did it change Current status / plan for restoration of services

Transferring service to do urgent vascular cases that are putting patients at risk by delaying too long. This may include work transferred back to the Trust from the Nightingale Hospital as the main vascular units across London have agreed to do a rota to cover Vascular cases - Move from ICHT and cases that will be referred out of the Nightingale. (Emergency LNWUHT to Bupa Cromwell vascular work will continue to be completed under the current COVID-19 guidelines). Will enable Trusts to concentrate fully on COVID-19 ITU cases and significant benefits to patients who are potentially at risk of deteriorating quickly. 26 Temporary changes we have made in recent months to ensure safe services Acute Hospitals – Chelsea and Westminster Hospital NHS Foundation Trust

Area of change Why did it change Current status / plan for restoration of services

COVID-19. • Early pregnancy complications requiring medical/ Under regular review and surgical and anaesthetic intervention leading to less pressure on EPAU - Move from CW and WMUH to challenge as part of the CPOD lists to manage acute emergencies and cancers, nurses can the Lister planning for return to business be redeployed to assist in COVID-19 rota and timely surgical as usual. management to avoid early pregnancy complications

Elective care commencing centred at Chelsea and Elective care suspended. Urgent care focussed at Chelsea Paediatric surgery focussed at Westminster. Under regular and Westminster to free capacity needed for pandemic Chelsea and Westminster review and challenge as response. part of the planning for return to business as usual.

Under regular review and Private Patients - Adults / Paeds - Elective care suspended. Side room capacity (as provided in PP) challenge as part of the Suspension of service needed for pandemic response planning for return to business as usual.

ACU - Suspension of service for new Maintain communication with patients. Continuity of care for patients HFEA recommendation based on patient safety grounds patients and reactivate the where treatment had started services

27 Temporary changes we have made in recent months to ensure safe services Mental Health Providers – Central and North West London NHS Foundation Trust

Area of change Why did it change Current status / plan for restoration of services

Process regarding next steps COVID -19. CNWL consolidating beds onto a reduced number of in being taking through sites to maintain safe staffing and level of service at the remaining appropriate governance forum. Gordon Hospital: Inpatient Wards – inpatient units, emergency hubs and other critical services. Wards remain closed during Closure this period to enable staff flex (Westminster) Patients who continue to require inpatient care have been transferred and redeployment as required to the other Trust inpatient units. incl. for emergency hubs and HBPoS needs

Closure was temporary for COVID -19. CNWL is consolidating beds onto a reduced number of COVID isolation beds - sites to maintain safe staffing and level of service at the remaining followed by some further Park Royal: Inpatient Wards – inpatient units, emergency hubs and other critical services. Closure temporary closures to enable

(Brent) long term planned works on Patients who continue to require inpatient care have been transferred eliminating dorms. This has to the other Trust inpatient units. now been reopened

28 Temporary changes we have made in recent months to ensure safe services Mental Health Providers – Central and North West London NHS Foundation Trust (continued)

Area of change Why did it change Current status / plan for restoration of services

COVID -19. CNWL is consolidating beds onto a reduced number of sites to maintain safe staffing and level of service at the remaining Currently open to 8 patients Vincent Square Eating Disorder Unit inpatient units, emergency hubs and other critical services. (from 15) to allow for social (inpatient) – Closure distancing. Day patient and (Kensington & Chelsea) Patients who continue to require inpatient care have been transferred assertive community outreach to either Lavender Walk (CNWL) or South West London & St in operation George's inpatient units.

COVID -19. CNWL is consolidating beds onto a reduced number of Service now open to inpatients. Under-12s unit – Closure sites to maintain safe staffing and level of service at the remaining Limited admissions to manage Beatrice Place - Collingham Child and inpatient units, emergency hubs and other critical services. Family Centre social distancing. Day school

(Kensington & Chelsea) and assertive outreach in Patients who continue to require inpatient care have been transferred operation to Lavender Walk

29 Temporary changes we have made in recent months to ensure safe services Mental Health Providers – Central and North West London NHS Foundation Trust (continued)

Area of change Why did it change Current status / plan for restoration of services

COVID-19. Mental Health Emergency Assessment Centres To be reviewed re long term Hillingdon Hospital (emergency hubs) co-located on acute sites at Hillingdon Hospital, impact and needs re Northwick Park Hospital , with units at Brent HBPoS and St Charles emergency pathway, as part of Brent HBPoS St Charles Hospital - Service change Hospital. Aim to provide dedicated areas for assessment of mental the planning for return to new health emergencies normal

Given the unit is one of the few intermediate care units which has Service now operating piped oxygen the environment, skill mix an medical cover has been primarily as a rehab unit (pre Hawthorne Intermediate Care Unit - enhanced to allow rapid discharge from acute for COVID+ patients COVID model) with dedicated Service enhancement who have reached a ceiling of care and are unable to go home. This and separate space available (Hillingdon) is designed to support rapid discharge from THH, particularly for for COVID+ patients if needed. those who are not suitable for ventilation Model agreed with NWL

Older adult patients have been absorbed across wider CNWL estate Unit now has 8 older adult to free up an additional 9 beds to provide low acuity intermediate beds. This allows the unit to Oaktree Older Adults Ward - Closure / care, particularly for COVID- and COVID+ patients who are medically manage social distancing and New Service Model optimised but not able to return to normal place or care or require a local demand. Staff supporting (Hillingdon) new care package to be established. The ward has maintained 6 assertive outreach and beds for local Borough Older Adult MH patients community older adult CMHT

30 Temporary changes we have made in recent months to ensure safe services Mental Health Providers – West London Trust

Area of change Why did it change Current status / plan for restoration of services

COVID -19. The Trust provided Tier 4 specialist personality disorder service from The Cassell , this service includes Cassel Hospital (M/F Eating assessment and treatment for adults and young people with Disorder services) – Closure severe and complex personality disorders. Cassell beds have Re-opened (NHS England commissioned service) been vacated and minimum staff remain in the building (limited to some use by Managed Clinical Network (MCN) staff only – most of MCN work is becoming virtual).

COVID -19. Robyn Ward which was previously a Mental Health Lakeside MHU (Robyn Ward) – As part of the planning for Reconfiguration High Dependency Rehabilitation ward is being used as a step return to business as usual (Hounslow) down ward for MH inpatients.

The Trust is operating 2 HBPOS (s136) suites in COVID -19. WLT has consolidated adult mental health inpatient Hounslow and 1 HBPOS St Bernards Hospital Ealing beds to 2 of its sites (Hounslow and H&F) to maintain staffing (Hope, Horizon, s136 suite and Mott suite in H&F borough. Work within inpatient units. Ealing patients that continue to require wards) - Closure is currently on-going to inpatient care have been transferred. develop dedicated staffing for this service.

31 Temporary changes we have made in recent months to ensure safe services Mental Health Providers – West London Trust (continued)

Area of change Why did it change Current status / plan for restoration of services

COVID -19. WLT has consolidated the older people beds on Hammersmith & Fulham Mental As part of the planning for Health Unit Jubilee Ward and vacated Meridian ward. Meridian ward is being return to business as usual (Meridian ward) - Reconfiguration repurposed for Front door ED at the H&F MHU.

Hammersmith & Fulham Mental COVID -19. WLT has allocated as COVID ward to cohort COVID As part of the planning for Health Unit positive patients from both Hounslow and H&F wards. return to business as usual (Avonmore ward)

Enhanced SPA with qualified clinicians, including addition of Single Point of Access – Change As part of the planning for (Ealing, Hammersmith & Fulham Consultant Psychiatrists from Primary Care mental Health return to business as usual and Hounslow) Services into SPA.

Mental Health Emergency pathway – Change In order to relieve pressure on Acute Hospital EDs, the assessment of patients presenting with mental health issues has Hubs established at: As part of the planning for • Lakeside MHU (Hounslow) been diverted to mental health providers. The Trust has worked return to business as usual • Hammersmith and Fulham MHU closely with the three local EDs to develop clear SOPs and • St Bernard’s Wolsey Wing ensure there is a robust diversion pathway in place. (Ealing)

32 Temporary changes we have made in recent months to ensure safe services Mental Health Providers – West London Trust (continued)

Area of change Why did it change Current status / plan for restoration of services

Primary and Community Mental Health services have been combined and work from community mental health team bases in each borough. All patients under the care of the combined service Primary and Community MH have been RAG rated and managed accordingly. This is informed Services – Reconfiguration As part of the planning for by both mental and physical healthcare needs and addresses the (Ealing, Hammersmith & Fulham return to business as usual and Hounslow) needs of ‘shielding’ patients. There are no direct referrals to primary care mental health services; all referrals of new patients should be sent via the SPA to ensure that they are managed equitably.

IAPT remains fully integrated into the overall system and supports those patients most at need. From Monday 23rd March 2020, all complex referrals come via SPA and no self referrals are accepted. IAPT As part of the planning for (Ealing, Hammersmith & Fulham return to business as usual and Hounslow) IAPT services have suspended face to face appointments and offers telephone/video and computerised CBT to patients with depression, social anxiety, panic disorder, low self-esteem, OCD, generalised anxiety, diabetes and COPD.

33 Temporary changes we have made in recent months to ensure safe services Mental Health Providers – West London Trust (continued)

Area of change Why did it change Current status / plan for restoration of services

Perinatal Services – Change This service continues to receive referrals in the usual way; has RAG As part of the planning for (Ealing, Hammersmith & Fulham and rated caseloads and is working through more telemedicine ways. return to business as usual Hounslow)

The Trust has amalgamated the four community CIDS team down to two teams covering the three boroughs.

CIDS has temporarily ceased all Dementia assessments, and have stopped all face-to-face patient contact. CIDS Community – Reconfiguration Services planned to re-start 13 (Ealing, Hammersmith & Fulham and The CIDS team are not accepting referrals at the current time, July Hounslow) however for urgent queries that wait and require immediate advice GPs are asked to call the service directly. For patients known to the CIDS team, a reduced service is still operating which includes monitoring and advice on medication and treatment via our duty system.

34 Temporary changes we have made in recent months to ensure safe services Mental Health Providers – West London Trust (continued)

Area of change Why did it change Current status / plan for restoration of services

Referrals to CAMHS are focussed on higher levels of need and CAMHS Community – change emerging mental illness. All Trust CAMHS services are able to As part of the planning for (Ealing, Hammersmith & Fulham and receive and process referrals through the usual mechanisms at return to business as usual Hounslow) present but cases will increasingly be prioritised on severity of need.

Trust’s CAMHS leads are developing emergency access sites away from A&E to CAMHS Alliance crisis team supports specialist services with cases contribute to relieving the that have escalated needs and also support early discharge from tier burden on acute sector 4 units to allow flow-through and capacity to be maintained. Three emergency services. CAMHS Crisis – change borough Alliance CAMHS Crisis team is continuing however in more (Ealing, Hammersmith & Fulham and virtual way than before. Access is via local CAMHS from 0900 to Hounslow) Cross sector collaboration is 17000; and via MH SPA after hours who direct referrals to OOH taking place via weekly CAMHS (this provision has been bolstered) London-wide CAMHS group,

led by NHSE, to support co-

ordination of services and newly developed pathways during the crisis period.

35 Temporary changes we have made in recent months to ensure safe services Community – Urgent Treatment Centres / Urgent Care Centres

Area of change Why did it change Current status / plan for restoration of services

COVID-19. The of people attending the centre has reduced dramatically over recent weeks in line with Government guidance and As part of the planning for Hammersmith UTC - Closure people avoiding social contact. Staff will be redeployed to support the return to business as usual COVID-19 response, providing clinical support and care for our most vulnerable patients.

COVID-19. The number of people attending the centre has reduced dramatically over recent weeks in line with Government guidance and As part of the planning for St Charles Urgent Care Centre - Closure people avoiding social contact. Staff will be redeployed to support the return to business as usual COVID-19 response, providing clinical support and care for our most vulnerable patients.

36 Temporary changes we have made in recent months to ensure safe services Community - Walk-in Centres

Area of change Why did it change Current status / plan for restoration of services

COVID-19. The number of people attending the centre has reduced dramatically over recent weeks in line with Government guidance and As part of the planning for return Parsons Green Walk-in Centre - closure people avoiding social contact. Staff will be redeployed to support the to business as usual COVID-19 response, providing clinical support and care for our most vulnerable patients.

COVID-19. The number of people attending the centre has reduced dramatically over recent weeks in line with Government guidance and As part of the planning for return Soho Walk-in Centre - closure people avoiding social contact. Staff will be redeployed to support the to business as usual COVID-19 response, providing clinical support and care for our most vulnerable patients.

COVID-19. The number of people attending the centre has reduced Pinn Walk-in Centre - Service currently dramatically over recent weeks in line with Government guidance and Exemption in place until 2021 for operating as a cold extended access people avoiding social contact. Staff will be redeployed to support the service to continue. hub to manage non-coved -19 activity. COVID-19 response, providing clinical support and care for our most vulnerable patients.

Earl's Court Walk-in Centre - closure Outcome of patient and public engagement Closed

37 Temporary changes we have made in recent months to ensure safe services Community - Other

Area of change Why did it change Current status / plan for restoration of services

COVID-19. The reason for closure was also due to the high level of As part of the planning for return Mount Vernon (THH) - Closure sickness/absence at both the MIU site and Hillingdon Hospital along to business as usual with a fall in the number of attendances.

Provide 20-25% of the original contract - staff redeployed into acute Sexual Health Services (LNWUH) - sector. GPs were notified and patients were notified via the bespoke Suspended walk in services sexual health website.

10 Hammersmith Broadway and St Reduced demand, need to undertake consultations remotely and Timings dependent on demand Stephen’s Centre (ChelWest) - SRH and requirement to redeploy staff allowed concentration of services on and on-going requirement for HIV services moved to SHL and 56DS one site. Reallocation of space for Staff COVID testing COVID staff testing

Sexual Health Hounslow (ChelWest) - Reduced demand, need to undertake consultations remotely and Timings dependent on demand Feltham, Heart of Hounslow spokes requirement to redeploy staff allowed concentration of services on and on-going requirement for closed, moved to Twickenham House, COVID staff testing on-line testing through SHL commenced one site. Reallocation of space for Staff COVID testing

Community services (NWL–wide) - COVID-19. Once a discharge decision has been made the patient will Reorganisation of community services to be moved to a designated discharge area within one hour, discharge ensure fast discharge from acute from hospital should happen as soon after that as possible, normally hospital setting during the COVID-19 pandemic. within two hours.

38 Appendix B: Out of Hospital and mental health summary priorities

Priorities for the OOH Recovery Plan, delivered through an ICS framework and a focus on Integration

Summary

A: Reactive care: B: Proactive care: proactive, preventative and C: Caring about the discrete / episodic integrated population health management , delivered through integrated services whole person

First contact referring into Responsive pathways of Public health actions Discharge, re-ablement People with long term conditions* urgent & emergency care planned for population and rehabilitation services Long Term Conditions Last phase of People who live • Taking a holistic • Accessed through 111 (talk • Accessed following a GP • Public health • Discharge Hubs - support through Integration life in care homes approach to a before you walk) with consultation, and interventions as people to leave hospital person’s needs, onward referral into either involving further planned episodes, quickly and safely. • Supporting self- • Integrated MDT • Having an • Getting the right A&E, a hot-hub, or into a scheduled interaction(s) covering health checks. • Community rehabilitation care approach to LTCs and agreed health NHS support to PCN / GP practice for triage with diagnostics Focus on Children's pathways – COVID-19 • Connecting older people/frailty. and care plan residents and call-back. (pathology or imaging) Imm & vaccs, and flu. Protect & COVID-19 Risk wellbeing, mental • Consistent Rapid Response and specialist advice. • Review approach to Managed. Consistent • Consistent minimum • Support to • Consistent and physical specification, and direct • Talk before you Walk minimise harm from service specifications. service specifications people and services health. their families access to 111/LAS across community people not seeking • Continued assessment of • WSIC/PHM to prioritise • Stability for the • Taking an assets- when they • Maintain appropriate same clinics. medical care through community bed capacity. patients and inform care home based approach approach the day primary care access • Advice and Guidance as Covid. care. market and helping • Post Covid-rehabilitation, end of life standard for non-urgent • Understanding impact continue monitoring within • Strategic development • Consideration of people to engage • Resilient Outpatient referrals of Covid on CYP, to LTC management of PC at scale through NHS input to their time and hospice sector develop support PCNs, integrated with supported living talents in their community & MH communities. teams.

Safety first Working with and through communities One team approach Digital and data driven Tackling inequalities

* Note: ‘People with LTCs’ refers to managed care to cohorts of people with ongoing health needs, including frailty and dementia

40 Draft mental health priorities for joint focus across local authorities and health

• Children and Young People – both transition and support for children not currently in school, as well as supporting their return to an education setting • Better support for those with learning disabilities and autism as well as those with challenging behaviour without a diagnosis • Substance misuse • Social prescribing and more generally, greater investment in VSCE organisations • Workforce – particularly recruitment challenges

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