Reducing unnecessary CYP admissions in the North East

To reduce the number of children and young people needing to travel out of area, CNTW opened up ten beds at the former hospital site, meaning the children with the greatest need were able to access an inpatient bed closer to home. But in tandem with this, TEWV undertook a more fundamental review of its provision, analysing its community offer, its crisis offer and its intensive home treatment offer, to see if it might be possible to care for a greater number of patients outside an inpatient setting.  

The trust’s crisis and intensive home treatment service (CRHT) for children and young people provides specialist triage, assessment and intensive home treatment for people aged up to 18 who need urgent mental health care. The team also supports young people experiencing an inpatient stay to return home more quickly.  

The team works with patients to draw up a care plan, potentially including safeguarding, signposting information and advice, a referral to another service or recommendations to the patient’s GP, a period of intensive home treatment or a hospital admission.  

Intensive home treatment (IHT) involves daily face-to-face visits for the first three days, followed by a programme of face-to-face visits and/or telephone consultations tailored to suit the patient. Staff provide supportive, listening, care and can also arrange psychological care, medication, practical support and advice. Patients’ care is reviewed daily by a multidisciplinary team (MDT) and MDT staff work with the patient to plan their discharge. They can also develop a crisis plan in case of future need. The team is nurse-led with senior psychology input and access to psychiatry as required. 

Alongside this service, specialist eating disorder IHT staff can visit patients at mealtimes in their homes and on paediatric wards if a patient has been admitted with an associated physical health need. And an intensive positive behavioural service (IPBS)  offers support for young people with learning disability or autism to help prevent unnecessary admissions in this patient cohort. 

The area covered by the IHT service includes both urban and rural areas. The service is able to work flexibly to address need in rural areas, to avoid a situation where different levels of provision are available depending on the level of rurality. For example, clinicians in one locality may provide additional telephone support to the team in neighbouring areas, to free up clinical capacity in that area.  

As a result of this work, TEWV has significantly reduced its rates of admissions (23 young people admitted in 2024 compared to 111 young people admitted in 2016) and is admitting the fewest young people in the North East.  

The CRHT approach has allowed for fast triage of patients in a crisis, meaning urgent referrals and follow-ups can be put in place quickly, usually within a four-hour window. The service is able to liaise closely with community CYP teams and social workers, and within the Durham geography there is also access to a parent peer worker. This means the families of patients are also able to build a good relationship with service providers.

The redesign of the community services came about because of the need to change service provision in the wake of an inpatient unit being closed because of concerns with the service. Recent independent reviews commissioned by NHS England have found that those concerns have been addressed and the service is offering care at or above expected standards for those with complex and enduring mental health needs.