Caroline Gadd is an NHS Innovation Accelerator Fellow and Director of Otsuka Health Solutions. Here she writes about how her innovation, Management and Supervision Tool (MaST), has adapted during the COVID-19 pandemic.
When the COVID-19 pandemic hit the UK, it wasn’t long before the potential impact on mental health services became a concern. I joined a national taskforce led by Positive Practice in Mental Health Collaborative and heard the significant concerns from health and social care professionals, charities and service user groups across the country. Mental health services were already under pressure and COVID-19 itself, along with associated restrictions to people’s lives, were anticipated to have a dramatic effect.
I lead a small digital health business and in the Spring of 2020 we were providing MaST, a decision support tool to three mental health trusts in England to improve their caseload management and allocation of resources, identifying people who may be at greatest risk of using crisis services and improving patient flow.
Whilst these challenges remained important during the COVID-19 pandemic, health professionals now describe additional pressure of cohorts of individuals whose mental health is deteriorating because they have been shielded and have other social and physical vulnerabilities. Social distancing meant that some community care had moved from face-to-face contact to virtual contacts, adding further challenges to the ability of services to respond to increased risk and need.
So with the help of a grant from Innovate UK, we collaborated with Mersey Care NHS Foundation Trust and earthware, our technology partner, to create a COVID-19 version of MaST. This update enabled staff to identify, intervene and ensure the safety of their most vulnerable service users, assessing whether a change in care would be needed during this turbulent time.
Being in a crisis situation provoked a change in attitudes and responsiveness. Decision makers and multiple agencies worked in an integrated way, sharing essential data and information and agreeing a common approach.
The MaST project team worked together using an Agile methodology, producing a minimum viable product that staff could start to use within 14 days. The fully functional MaST COVID-19 dashboard was launched within six weeks, with additional data sources added to the mental health records including shielded patient lists, physical health and social care data.
Mersey Care involved 50 clinical staff in the project who were unable to contribute to face-to-face clinical activities due to their own shielding needs or requirements to support family members at home. The clinicians used MaST COVID-19 to help prioritise telephone calls to patients, carers, GP and other professionals.
I observed and heard reports of very strong leadership of the hospital project teams as well as executive advocacy, peer support and rapid learning via MaST online training. This is why the team were able to identify, contact and assess 7,312 vulnerable people over a six-week period, prioritising 2,381 shielded people with dementia and 1,107 with psychosis who were assessed within two weeks of the project start and then supported appropriately.
Some people, when contacted, were found to be expressing suicidal thoughts and were offered essential and urgent support with proactive follow up. These people have since expressed the difference those calls made. Others shared feelings of loneliness, fear and recent bereavement and were able to talk through their anxieties. They felt listened too and reassured that they were still on the radar of service.
The staff involved told us that without a dashboard like this they would have had to spend hours and hours looking for the right information in care records, and even then the picture may have been incomplete. They would have had to rely on colleagues having knowledge of the people cared for across a broad range of services and felt that the project would have been too complex and unwieldy to feel engaged with.
It didn’t all go smoothly of course. It was important to keep updating the data feeds, and loading large files overnight meant that some staff were waiting to start in the morning. Finding ways to allocate caseloads was sometimes difficult because workers were changing each day meaning there was no fixed team.
However, we have definitely learnt that with the right set up, project team, clinical leadership and urgency to complete a task, it is possible to get a digital solution developed and deployed for staff to use quickly. The benefit of combining data sources by integrating mental and physical health data with social care data provides staff with a more holistic view of people’s risk of using urgent care services.
Community Mental Health Services need to be transformed so that they are sustainable for the future, using NHS England’s ‘Community Mental Health Framework for adults and older adults’ (2019) alongside lessons learned from the delivery of mental health care during the pandemic. The framework describes how services should be delivered collaboratively, meeting the needs of local communities and addressing inequalities which have become more pronounced during the pandemic.
Many of the aims of the framework such as ‘Promote mental and physical health, and prevent ill health’ and ‘Build a model of care based on inclusivity, particularly for people with coexisting needs, with the highest levels of complexity and who experience marginalisation’ are reliant on a joined-up and representative multidisciplinary team with data, information and analytics which inform effective and efficient decision making. So we are continuing to adapt and develop MaST to address this need with system level insights including predictive analytics and indicators of quality and safety that are meaningful to the range of providers.
The COVID-19 outbreak has really drawn attention to the need to keep learning about how to provide the best possible care for complex, vulnerable people and communities. We have demonstrated that support tools such as MaST can make a real difference, and I hope that this sort of innovation will continue to be welcomed as we move forward into a sustainable future.