Action one: Develop strong relationships and shared understanding

In Essex, the team developed a strapline for their project: How do we care better for our patients, together?

The aim by the end of their project was for 100 per cent of patients with mental health needs in ED to have an integrated care plan ensuring patient safety and shared decision-making by East Suffolk and North Essex NHS Foundation Trust (ESNEFT) and Essex Partnership University NHS Foundation Trust (EPUT) as well as patients, families and carers.

The team made a number of improvements, which all form part of the crisis care and pathway improvements for north-east Essex:

• Clear and efficient protocols to achieve the agreed individual outcomes for MH patients in ED.
• Jointly owned and regularly reviewed plan of care and support for most MH patients in the ED.
• Enhanced communication and relationships across acute and MH teams, including joint daily team huddles to improve continuity of care.
• Mental health training delivered to ESNEFT acute staff by an EPUT psychologist and plans to repeat this after six months.

A repeat quality visit found progress against the aims and objectives of the interface improvement programme. This included patients now having access to shower facilities, food and water, and were happy with all the care they had received. No concerns were raised, and feedback showed that staff were supportive and kind.

ESNEFT and EPUT have agreed to continue the work and ensure these improvements are continuously embedded into daily practice. An action plan has been designed and will be owned by ESNEFT and EPUT to deliver and sustain the work done to date.

In Kent and Medway, the key impact of this programme was a tangible shift towards more coordinated, compassionate and timely care for children and young people experiencing mental health crisis in the emergency department. By focusing on reducing prolonged ED stays (over 24 hours), the team directly addressed some of the most distressing experiences for a small but highly complex group of young people and their families. Although the numbers affected were relatively small, the impact was significant in terms of safety, experience and system pressure, with early improvements achieving a reduction of prolonged stays by 30 – 35 per cent. Importantly, the work also reduced confusion and blame between partners by clarifying shared responsibility across the system.

This impact was enabled by bringing system partners together around a shared understanding of the problem. Through the application of quality improvement and human factors principles, the team developed a collective view of why long waits were happening - looking beyond single organisations to examine processes, environments and team interactions. Pathway mapping, data review and the active involvement of experts by experience helped ground this understanding in real-world impact, keeping the focus on children, young people and families rather than organisational performance alone.

Strong relationship building across agencies was another critical enabler. By working collaboratively across acute, community, mental health, local authority, ambulance and VCSE partners, the programme strengthened multi-agency decision-making and crisis pathways. Dedicated task and finish groups focusing on triage, escalation and environment created practical spaces for joint problem-solving, while cultural shifts - away from ‘whose responsibility is this?’ towards shared ownership - began to break down entrenched organisational boundaries.