Case Studies
IMPOWER was commissioned by partners across the mental health system in Surrey to help reduce the length of time patients spend in hospital while improving outcomes.
Like many parts of the country, the county faces complex and growing pressures that make it difficult to provide the right support at the right time. This leads to rising demand and costs, longer stays in hospital and a heightened risk that a person’s health will deteriorate.
Surrey and Borders Partnership NHS Foundation Trust, the main mental health acute provider in Surrey, together with Surrey County Council and Surrey Heartlands Integrated Care Board tasked the IMPOWER team to help:
- Improve outcomes for people experiencing mental ill health, their families and carers
- Reduce inpatient length of stay (LOS)
- Ensure that people in inpatients wards are discharged as early as possible once they are deemed clinically ready.
Working alongside clinicians on wards, we built a clear picture of what was happening and identified areas for improvement – in particular, the opportunity for a culture shift towards strengths-based practice. We could see that by putting a person’s strengths, aspirations and needs at the heart of conversations, this would have a knock-on effect on lengths of stay and outcomes.
It was also key to bring the voice of patients and their families and carers into those conversations.
At the heart of our work was a focus on changing day-to-day frontline behaviours, practices and ways of working in order to usher in a more collaborative and strengths-based approach and culture that looks to support safe discharge. We drew upon Valuing Home, IMPOWER’s tried and tested approach that puts people, families and carers at the heart of those changes in order to deliver the best possible outcomes.
The majority of our work during the project was with the NHS trust, working alongside clinicians on wards to both understand what was happening on a daily basis and build relationships that were key to us becoming trusted advisors. By doing so we created a safe space for staff – who are often under immense pressure – to talk freely about their work and any barriers they were experiencing in providing the seamless care they wanted for their patients.
We initially focused on a cohort of patients who had been on the wards for the longest time, and were therefore most at-risk for unsustainable discharges, to really understand their aspirations and needs. Having an impact on these patients helped to build confidence in the new approaches.
We created a constant feedback loop where the insight gained from widespread conversations was shared with key players at every level within each client. This enabled us to quickly highlight our initial findings, trial new approaches and evidence their impact – all of which helped to build confidence in our work and a willingness to embrace change within a highly pressurised environment.
We introduced a number of interventions, co-produced with staff and informed by feedback from patients, families and carers. They included:
- Redesigned multi-disciplinary team (MDT) meetings to make them more strengths-based so they facilitate conversations around what’s required for a patient to reach a point where they can be safely discharged to community support
- Introduced multi-agency discharge events, bringing together the ultimate decision makers and ensure they get to hear the feelings of patients
- Introduced MDT ‘action huddles’ that ensure each day’s actions are owned by a named person and progress is shared at the next meeting
- Created action discharge plans for each patient with all partners having collective responsibility for getting people back home
- Co-designed a fresh approach to new admissions meetings that bring together community and ward teams so that future discharge is considered from the outset. Plans are now underway to pilot the approach.
The project has delivered: better outcomes for people and their families and carers through improved discharge planning; a reduction in people waiting for an acute mental health inpatient bed, so that the right people are able to get the right support at the right time; a reduction in average length of stay; and an increased number and rate of discharges, alleviating pressures across the system.
Between November 2023 and May 2024 we supported:
- 45% reduction in demand for people waiting for an inpatient bed
- 5.5 days fall in average length of stay on wards – reducing the average cost of admission by £4,140
- c£582,000 reduction in the cost of admissions through more person-centred and proactive discharge planning
- 17% decrease in patients staying 90+ days in an inpatient bed
- A decrease in operational pressures escalation levels, known as the OPEL score and used to gauge pressures within a hospital, highlighting how changes have had an impact on mental health patient flow
- More involvement of patients and their families/carers in discharge planning.
Co-production was built into the project from the outset in order to nurture a sense of ownership and ensure new ways of working continue to be embedded long after we have exited.
For example, co-designed ward leadership coaching and training, which will build confidence in managing change and create opportunities to reflect and share learning while supporting a more consistent approach across wards.
In our final report to the clients, we set out a series of recommendations for each partner to help them enhance and further embed improvements. These were based on a combination of interviews and data analysis to develop a diagnostic report, for example outlining opportunities for more effective system-wide commissioning for mental health and better cross-agency working.
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