Q Exchange
Improving the Psychiatric Decisions Unit (PDU) in Sheffield
- Winning idea
- 2024
Meet the team
Also:
- Raihan Talukdar
- Sam Jeffries
- David Bussue
What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?
The PDU in Sheffield is under utilised, the reasons for which are currently unknown.
Nationally, mental health patients account for 16% of all 12-hour waits in A&E. Patients experience a lengthy triage process, speaking to multiple professionals, including those who exclusively require mental health support. The PDU could be an alternative to this pathway.
Previous interactions within Sheffield Health and Social Care, Sheffield Teaching Hospitals and Yorkshire Ambulance Service highlighted a lack of awareness and understanding of the PDU and its uses. There is an existing collaboration with the ICB to improve the Urgent and Emergency Care (UEC) pathway.
Following engagement events, it has been highlighted that service user perceptions of the PDU also contribute to low referrals. Therefore more emphasis on service user feedback is required. Alongside the above Trusts, we will work with our partner charity, Sheffield Flourish, and Experts by Experience to incorporate service user feedback.
What does your project aim to achieve?
To improve the utilisation of the PDU by increasing referrals by 30% by July 2025.
To provide a better patient experience by bypassing A&E to experience a quieter and more appropriate environment, and be assessed by mental health professionals quicker, keeping with the NHS principle of right person, right place, right time.
To reduce the demand for mental health support within Sheffield’s A&E through training, education and increased dissemination of information regarding the PDU.
It is timely to consider this pathway now in line with the recent NHS 111 ‘Option 2’ service and Flourish’s current work developing culturally appropriate crisis information for Sheffield communities.
Health inequalities on the PDU were highlighted in our Trust’s 2023 data, such as overrepresentation from deprived areas, LGB communities and certain ethnicities. We will address this by working with our VCSE partners, particularly Flourish and SACHMA, who have already expressed interest in this project.
How will the project be delivered?
Phase 1: Information gathering.
Survey SHSC staff regarding current knowledge of the PDU as baseline data.
Review PDU capacity usage and referrals, including those declined by the client.
Meet with PDU staff to process map the current pathway and measurable outcomes such as waiting times before attending the PDU.
Plan how to gather feedback from service users with lived experience of the PDU.
Phase 2: Develop awareness sessions/focus groups.
Using information gathered in Phase 1, develop appropriate resources and sessions for SHSC, STH and YAS staff.
Co-design service user focus groups with support from Sheffield Flourish (VCSE).
Work with other organisations (e.g. SayIt) to ensure our training considers health inequalities.
Phase 3: Deliver sessions/focus groups
Using PDSA methodology, deliver sessions across SHSC, STH and YAS as required.
Work with Sheffield Flourish to collaborate with service users.
Phase 4: Ongoing evaluation
Repeat SHSC staff survey about PDU knowledge.
Review PDU data.
Share learning with others.
How is your project going to share learning?
There has been interest from South Yorkshire Police to be involved in this project, a service we would like to scale up to include at a later point after running this initial project.
There are only six PDUs across the UK, therefore projects such as this will be valuable to other PDUs as well as areas considering whether to invest in setting up their own PDU.
We have reached out to existing PDUs who have different ways of running their services and there has been interest in a shared learning platform.
There may also be learning for other A&E departments and ambulance services where there are not existing PDUs who may want to consider their pathways.
We aim to attend conferences to share our learning nationally.
Continued training for SHSC, STH, YAS and third sector organisations. Previous training has been provided, but there is demand for more.
How you can contribute
- Provide comments and feedback on this project.
- Networking opportunities with other mental health trusts interested in PDU implementation.
- Experience of effective co-production.
- We welcome any other organisations who may wish to be involved.
Plan timeline
| 8 Jul 2024 | Begin Phase 1 |
|---|---|
| 2 Sep 2024 | Begin Phase 2 |
| 3 Feb 2025 | Begin Phase 3 |
| 7 Apr 2025 | Begin Phase 4 |
Comments
Jenny Marshall 29 May 2024
Thank you everyone for sharing comments, questions and feedback regarding this project; they've been really helpful in pushing us to consider our aims further. In addition to the Q comments, we held engagement sessions with the PDU staff, wider SHSC staff, experts by experience and met with the SY ICB.
Holly and I have revised the proposal with all of these conversations in mind, and have shaped it to have more involvement with service users and VCSE organisations. We have therefore increased the budget to reflect this change, ensuring service users, carers and voluntary sector staff are remunerated for their involvement in this improvement work. Feedback has highlighted that this is an integral part of understanding current PDU usage, and we hope this will allow for greater improvements to the service.
Helen Crimlisk 29 May 2024
So pleased to see this project shortlisted. It brings together ideas about improving an innovative concept - the decision unit - which allows a more flexible and person centered approach to urgent and crisis work within mental health. The over representation of people with social or other disadvantage is an opportunity to think differently about how this service can mitigate and address some of the social determinants of health. The recent 24/7 CMHT bid by NHS England is an exciting opportunity which many Trusts and communities are interested in and this QI project may be able to help inform us about how we can approach a different and more localized approach to crisis and urgent presentations?
rob carter 28 May 2024
I am pleased to see this bid and keen to offer my support. The Emergency Department struggles to provide appropriate support, indeed isn’t properly equipped to manage persons presenting in mental health crisis. The PDU has been in existence now for about 5 years and its essential that its’ utilisation is optimised to improve service user experience, by offering appropriate support in a safe therapeutic environment.
I am however also keen to receive an assurance that all existing initiatives to raise awareness of the existence and purpose of the DU are maintained and particularly that the relationship with STHFT Emergency Department is strengthened to ensure easy referral into the DU where necessary and appropriate
Francesco Palma 23 May 2024
I support this proposal for PDU, Having read the proposal it is heavy on clinicans and light on Patients & Carers input (or so it appears) so as to make Experience Based Co-Design not to be maybe considered.
Your pitch informs 'seen by the right person at the right time' elsewhere NHS111 Option 2 exists for non emergency mental health care as is the case in Sheffield Health & Social Care NHS Foundation Trust so how will the PDU compliment existing Urgert/Emergency care Mental Health services to include Crisis Care & Home Treatment, Laison Psychiatry, RAID
Early days but would be interested to hear which PREM's & PROM's have patients & Carer's considered & which CROM's for Clinicans.
Uncertain if the PDU will be located in/next/elsewhere to A&E if at A&E will patient/carer be able to self refer/Present to PDU? & is it the case that the section 5(4) & 5(2) holding powers will not apply? I only ask as confidence and trust between the patient/Carer needs to be established with PDU staff.
Holly Smith 28 May 2024
Hi Francesco, thank you for your comment and supportive words.
We have Sheffield Flourish involved, they are a charity who work with service users and we have plans for lots of co production with them.
Since we were shortlisted we have reached out within our organisation and we have involvement from out expert by experience team, our proposal will be updated to reflect these exciting developments. We are keen to work with service users as much as possible and we are passionate about providing the right care for the right person at the right time and service user involvement in quality improvement is key to this.
The PDU has been open in Sheffield for several years now, it sits on the same site as the larger of the two Teaching hospitals, which is also the site for A&E. However the PDU sits separately, in the mental health building which is also the site of liaison, home treatment and several other teams. The PDU currently works collaboratively with home treatment/crisis/liaison teams. Service users who attend A&E but require further assessment or more time to construct an appropriate treatment plan (which may or may not involve home treatment) can attend the PDU while these further assessments and planning takes place, instead of waiting for hours in A&E.
You raise an important point regarding holding powers under the MHA, and yes you are right that they do not apply on the PDU as it is not an inpatient ward, much like A&E. Service users must have capacity and consent to go to the PDU.
As for PREM's, PROM's and CROM's, Feedback has been sought from patients and staff before though I am afraid I could not comment on this as I do not know the details but we hope to work with the PDU staff to build on this.
Sid Fletcher 23 May 2024
I have always and will continue to be supportive of initiatives that provide appropriate and evidence based support to clients who are in crisis
For far too long A+E attendance or the use of emergency services such as Police and paramedic have had to utilised to provide support to users in crisis when it makes sense to provide support via other lesser restrictive alternatives that have better outcomes and fewer professional handovers - clients currently get passed around the system far too many times due to pressures on each service
Holly Smith 28 May 2024
Thank you for your comment Sid.
You make an excellent point regarding reducing the amount of handovers and professionals that a service user often speaks to, its not uncommon to hear service users say "I've just told the last person all this, can't you just read the notes" and they reluctantly accept we need to hear the story again and may have different questions, but this is distressing for service users who are often already quite distressed, possibly experiencing a mental health crisis, it seems more appropriate to cut out the middle steps if possible.
Louisa King 22 May 2024
I've commented before--I am supportive of the project--but could you advise how the project will link up with other crisis alternatives in the city, e.g. the Sheffield Support Hub? It's good you're working with Flourish who, through the Mental Health Guide, will be able to connect you to a range of other VCSE groups.
Jenny Marshall 24 May 2024
Thank you Louisa, this is a great point, and we'll make sure to include this in the updated bid.
By working with Flourish we hope to identify the different crisis pathways available to Sheffield residents, which will be used to develop the resource packs for service users. We hope this will provide the opportunity for informed choices of the available options. We held an engagement event this week to discuss this project, and some feedback from a participant with lived experience was that they would like a better understand of how to access the PDU. We aim to make the process clear in the resource pack, and will make sure to include similar information about access for other mental health crisis alternatives.
We're planning on running focus groups with service users, and also healthcare professionals from our partner Trusts STH and YAS, to develop resource packs for clinical staff as well as service users.
Sue Barnitt 17 May 2024
Having worked in both Acute and MH Trusts I can absolutely see the value of this project - people in the right place, receiving the right care from the right people. A much more positive approach which no doubt will improve the service users experience.
Sidra Chaudhry 16 May 2024
This sounds great! Really keen to see how this spans out!
Emma Brooks 16 May 2024
This sounds like an excellent initiative.
There is a huge appetite for improving training in this area amongst A&E clinicians and other professionals. Best of luck!
Alison Schofield 16 May 2024
Having recently visited this unit, I think this is a brilliant initiative that supports people to access the most appropriate service to meet their needs in the most appropriate environment. The unit is welcoming, bright and has lots of little extras which makes it feel less like a hospital and has a calming effect as soon as you walk on to it. Thus reducing pressure in the Acute setting - A&E/urgent care and improving patient experience. Collaborative working with the police and ambulance service is essential to the success. We had great success in Greater Manchester with the Mental Health Joint Response Car (MHJRV) which was to reduce 136 place f safety conveyance acro9ss Bolton, Salford, Wigan, Manchester. We had great partnership working with GMMH, GMP and NWAS which was pivotal to success.
Holly Smith 17 May 2024
Thank you for your comment Alison.
We agree that collaboration across the services will be key, this project will hopefully strengthen existing partnerships with services such as Yorkshire Ambulance Service and the Police force.
Greg Hackney 16 May 2024
I am really keen to support this initiative. We know that Emergency Departments are rarely a good environment for people presenting in mental health crisis. Psychiatric Decisions Units can provide a safe and therapeutic alternative. This could significantly improve the experience of people using our services and make more effective use of services. We need good collaboration across the health and social care sector to make this successful.
Louisa King 20 Mar 2024
The proposals in this project are really positive, and it is encouraging to see the support the proposal has from difference partners in Sheffield, including the VCSE sector.
I am really interested in the health inequalities aspect highlighted in the proposal above in particular. Can you highlight which groups specifically you will be working with, and the VCSE groups you will partner with?
I am also interested in how this might support young people aged 16/17 attending adults' A&E. Have you considered this?
Holly Smith 20 Mar 2024
Thank you for your comment Louisa.
We have already reached out to Flourish and plan to be guided by service user groups to identify which groups we can engage with and would see the most benefit from.
We have existing partnerships with SACHMA and the Pakistan Muslim Centre and plan to reach out to them to discuss how we can help to address the inequalities in those communities, which we already know exist from previous data.
We would like to build a relationship with Say It too. We have considered approaching this via our Rainbow Staff Network as they already have a connection.
As for 16/17 year olds, that is an excellent question that unfortunately I don't have an answer for. The PDU is not commissioned for 16/17 year olds though we do know that age group attend the adult A&E for emergency care only, but the secondary mental health is not provided by SHSC but by CAMHS which is under SCH. It is something that would be interesting to look at moving forward but I do not have an answer for you as yet.
Richard Hammond 14 Mar 2024
Is there a role for the police in this project? I would imagine we are a significant contributor to the number of individuals in A&Es for a mental health related issue, whether that be formally detained or on an informal basis. I have a lot of data regarding the time police officers spend in A&E with those detained under S136, due to the lack of available S136 specific beds. I do wonder if some of those detentions would occur / are necessary, if there was a known viable alternative. More than happy to discuss further.
Holly Smith 18 Mar 2024
Thank you for your comment Richard. Yes we would welcome input from police, I can only imagine how much time police officers spend in A&E with patients detained under S136. Legally if a patient is detained a place of safety i.e. A&E or a 136 bed are the only options but yes I wonder if police were aware there was an alternative and could liaise with the PDU and transport patients to the PDU directly (the patient would have to consent to this) this may also contribute to reduced A&E admissions.
Chris Powell-Wiffen 11 Mar 2024
This sounds like an excellent (and cost effective) way of helping patients access the best service for their needs earlier whilst reducing pressure upon Sheffield's 'physical health' urgent and emergency care services.
Jenny Marshall 21 May 2024
Thanks for your support, Chris - it would be great to link in and discuss how we can work together across the Sheffield trusts to address this further.
Jessica Anderson 27 Feb 2024
Hi, this sounds like a really interesting idea. I'd be really keen to learn more about how you're planning to deliver the training?
Jenny Marshall 27 Feb 2024
Good question, and one that will depend largely on the information we receive during the scoping process in Phase 1. As we'd like to work with a variety of sectors, we'd like to provide training that is most appropriate to the service, whether that's group sessions of in-person/online training led by a facilitator, website resources and videos for more bitesize learning, or materials such as leaflets and information booklets.
Helen Crimlisk 23 Feb 2024
This project illustrates the challenges of ensuring that innovative approaches to breaking longstanding referral routes are understood and actioned across system boundaries. PDUs are a fabulous way of supporting patients in crisis because of their mental health. They deliver a more appropriate environment, improved patient experience and free up space and time in A&E for those who need urgent physical health interventions. The engagement with networks and dats gathering around staff awareness and views, especially with the explicit focus on inequalities, will add value to understanding and also prompt stafg to considef how bedt to engage with wider system partners sch as YAS, STH,SHSC & VCSE to ensure this resourse is used effectively and equitably. The explicit involvment of partners such as SAYIT and Flourish demonstrstes a determination to work in partnership across systems.
How will you ensure the impact of this intervention and data collection will be shared with other PDUs and also support commissioners elsewhere to consider this approach?
Have you thought about how often issues of concerns re patient safety and also of patient choice play into decision making?
Holly Smith 4 Mar 2024
Thank you for your comment Helen, as Jenny has already said I have previously been in contact with other PDUs in the country to start the process of shared learning from each other, it was evident from those meetings that each unit operates quite differently, and we could all learn a lot from each other. I recently reached out again to the contacts from those PDUs to gain an understanding for the appetite for shared learning and my enquiries were met with enthusiasm.
With regards to your second question, we have linked in with a current quality improvement project happening on the PDU, the focus of which is improving the service out of hours from a medical cover perspective, which is hoping to address and highlight any safety concerns. As for patient choice, interesting question, one of the things we would like to do with this project is have substantial service user involvement, particularly feedback on the unit itself and the referral and discharge process, this is possibly one of the areas where Flourish or our in house Peer Support workers may be helpful.
Jenny Marshall 27 Feb 2024
Thanks Helen, some great points and questions raised here for consideration.
Holly has been in contact with other PDUs and I'm sure will be pleased to share the findings from this project if we're successful in securing funding. We have a separate workstream aiming to set up a PDU community/network, an idea which has received interest during conversations with national PDU colleagues.
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