Staff Choice Awards 2018/19
Innovation Award

Wellbeing Suffolk and Access and Assessment Team (AAT) and Integrated Delivery Team (IDT) managers

Is a finalist for this award


The nomination said...

The Suffolk Wellbeing Service and the Suffolk Integrated Delivery Teams work separately under different service lines. However, our patients in Suffolk do not see this distinction and when they need care stepped up or down want a smooth handover and transition between Wellbeing care and secondary care so they do not have to repeat their story.

So, recognising the difference in service provision and key clinical criteria, the Suffolk leadership teams came together to design a pathway where patients can transfer care in a safe and managed way to keep the continuum of care ongoing. Teams met to understand each other’s service model, the clinical criteria required by each team and the fundamental safety factors.

From this, a pathway model was designed, supported by Business Support, and key safety, core, risk and care plans were all considered. Because it was recognised there may be professional differences for care, the process allowed for an internal arbitration protocol so that this does not impact on the service user, and the teams work out the best care in a timely manner for the service user. This was a large-scale change and cut out any delay in transfer between primary and secondary care, and makes a difference for the patient getting the right care at the right time by the right professional in the right clinical setting. It has also encouraged cross working between primary and secondary care and greater understanding of the needs and pressures of service users and staff in each service line.

We would like to recommend in particular Lianne Nunn from the Suffolk Wellbeing Service and the AAT and IDT managers (on behalf of the Suffolk teams) for this award; for the positive attitude to drive through this change, for the co-operation and open willingness to make it a success and to the wider teams in delivering this revised process and making it a success. Service users now are transitioned smoothly and quickly into secondary care and back to primary care with no barriers.

In addition to the pathway designed, a criteria template was produced to describe the criteria to support the smooth transition for the U25 service provision. This supported the pathway flow. It was co-produced by all the U25 teams and Lianne, and it is used by clinicians to help understand clinically where a service user could access.

The principles applied by the teams were as follows:

  • Determination to design a pathway which was not burdensome on staff
  • Positively discuss clinical differences and recognise those but work to find a solution so this does not impact on the service user handover
  • Give regard to the Trust’s clinical standards of good care planning and risk management
  • Ensure the service user is not aware of the differences of provision and understand why they are being transferred to a new care professional, and to be kept informed of the transition
  • To not delay the patient care and to ensure it continues as they are in the NSFT service provision

I would like to praise the dedication by Lianne and Kathryn to design a pathway for step up and step down care. In meetings, I always evidenced the real desire to create and design a pathway which benefited service users and staff, ultimately because timely care was being provided in the right place.

Barriers to change were overcome by talking through the issues and seeing the benefits of the change. Lianne and Kathryn showed real tenacity to guide staff on-side to deliver.

It is because of this and the support of all the teams, I would like to nominate this pathway in the innovation award.