How we improved access to children’s services, referrals and information contact points in Devon

Bringing together all of the Children’s Services in Devon under a single organisation and allowing parents, carers and healthcare professionals to access them simply and easily via a single point of contact was one of our commitments when we began delivering the services in 2012.

Our vision is of a fully integrated service where young people, parents and carers only have to tell their story once and where everyone is able to access advice and support from our services whether they need early help, toolkits they can use themselves or formal interventions.

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Introduction

Virgin Care began providing Devon Integrated Children’s Services (ICS) in April 2013 after being chosen by the NHS and Devon County Council to transform the services to make them more integrated, more efficient, reduce waiting times and ensure services across the county were fair and equitable.

Part of our plan for delivering the services (known as our roadmap) was to deliver better integration between services, clearer referral criteria and better early help support for the less serious cases which need support but not intervention.

Feedback from children, young people, families and health professionals when we began running the services supported our vision. They told us they needed it to be easier to access services, clearer what they were eligible for or what kinds of support were available, shorter waits for services and self-help support tools for the time between a referral being made and treatment starting.

The Single Point of Access, based in Exeter but providing a truly integrated referral and advice system, launched in December 2015 and is the culmination of a two year project developing clear service criteria and referral requirements, developing an interactive and innovative single point of access advice and guidance website, aligning processes across services and working with our referrers and service users to develop a service that works well for everyone.

Other work has included developing:

  • Screening toolkits to support our education colleagues with better identifying issues young people face and making informed referrals
  • Self-help guidance for parents and families with more minor difficulties, best resolved at home
  • Support and advice content for anyone, available 24 hours a day online, facing a difficult – with actionable guidance and reassurance of the support they can access should they need it

Under a year after launching, we’re processing referrals more quickly so that people can begin their treatment sooner and our expert Single Pont of Access Team are ensuring referrals go to the right service for the difficulty being faced.

Service users report the website is helpful and useful and we’ve got clear oversight of the content and downloads so that we can improve it – and our referrers tell us that, once they try the new processes, they’re finding it’s simpler and easier than before to get the right support or advice.

But we’re not done yet.

In late 2016, we’ll begin work with the children and young people who use our services to develop additional content for the website to help our youngest service users better understand their own difficulties and the support we can offer them.

We’ll continue to promote the advice and support the SPA offers across Devon to make sure everyone is benefiting, and work to bring the Universal services we provide (like Health Visiting and School Nursing) into the SPA too.

And we’ll continue to improve the service based on feedback from across the health economy and the community.

Services were not well integrated and faced increasing demand

NHS NEW Devon CCG, NHS England and Devon County Council had identified that Children’s Health Services in Devon were not well integrated, facing increased demand and needed to be transformed to better meet the needs of families and health professionals in Devon and as part of a robust procurement process Virgin Care was identified as the provider to take forward these transformational changes over the course of a five year contract.

When we took on the services in 2013, we found:

  • A myriad of referral email addresses were in use, with even the same service having multiple referral routes
  • Telephone numbers GPs had for our services were often out of date, or for offices only staffed at certain times
  • The numbers our patients were calling us on for support and advice on their referral were often wrong – leading to inconsistent advice and a poor experience when no one was around to speak
  • The same service in different areas had differing criteria for accepting referrals or declining them; in some cases, referrals were automatically accepted and people who would be better served with support from a self-help toolkit or another service were waiting to access our service, delaying their treatment and providing a poor experience
  • Devon ICS had no presence online – and searches for support too often led to paid-for private services or, worse still, poor advice from non-authoritative websites which were causing parents unnecessary anxiety

As part of our plan for delivering services (known as our roadmap) we had identified that introducing clearer referral criteria, offering self and early help support tools families could use themselves and introducing a unified procedure for requesting support were an essential part of delivering our commissioners’ vision.

A focus group of GPs, service users and our colleagues which we ran at the start of 2015 agreed with our assessment of the problems. Despite a mutual ambition to cut paper and reduce administration, confusion was causing problems using electronic referral processes.

Implementing a Single Point of Access


SPA

Implementing our Single Point of Access in December 2015, giving everyone who needs to talk to us or make a referral a single phone number, email address, website and physical location to find all of our services, is the culmination of two years’ work where we’ve:

  • Developed, refined and aligned our referral criteria for each service – bringing consistency to services across the whole of Devon, to provide fair and equitable services
  • Recruited and trained our Single Point of Access Team, a group of experts trained in identifying referral routes and highlighting urgent cases across all of our services – and providing expert support and advice to the parents, carers and health and education professionals who we support
  • Developed, tested and deployed our self-help and early-help toolkits for parents, carers, children, young people and families to work on with more minor difficulties and while waiting for formal interventions from our services
  • Developed, tested and deployed screener and support tools for learning communities across Devon to better understand the difficulties their students face – and identify the right support for them
  • Developed, designed and deployed an interactive, innovative online single point of access – helping professionals, parents and children and young people find the support and advice they need, and better understand what they should do next to get the right support
  • Identified and reduced gaps in services by highlighting them to our commissioners

We invested heavily in ensuring the SPA team are well trained, well equipped and able to offer the best support possible to our service users and the work we’ve done over the past two years has meant our services are now consistent, fair and equitable no matter where they live in Devon.

A robust, clear management structure alongside administrative support and clinical leadership means we’re ensuring all referrals are reviewed before processing, those referrals we do not accept or need more information on are handled properly and clearly, and urgent cases are highlighted to the right team, in the right way, quickly.

Virgin Care set about to ensure we were offering the same threshold criteria for service eligibility across all Devon service areas, with waiting times and lists managed consistently across the county and patients had a contactable service for information.

Improvements in referrals, processing times, and triage

The SPA soft-launched in December 2015 covering our Children with Additional Needs services (Occupational Therapy, Speech and Language Therapy and our Child and Adolescent Mental Health Services), with an aim of including Universal Services (Health Vesting and School Nursing) and other services later in 2016.

Everyone can now access these services by calling one number (03300 245 321), one email (VCL.DevonSpa@nhs.net), and via one website which guides everyone on what they should do before contacting us and the information we need to accept a referral.


Service data

5,800 referrals processed in SPA’s first six months


Since the SPA launched, we’ve seen improvements in our referral process and feedback from health professionals tells us they have too. All referrals are now triaged by our specialist team to ensure they go to the right service – freeing up time for our doctors and professionals to focus on their day roles, and speeding up the response to the referrer and family.

In our first six months, we’ve processed 5,800 referrals from GPs, Schools, other NHS organisations which adds up to about 63% of all the referrals we received across Devon. Around 5% of those referrals even came from parents and young people themselves, a dramatic increase on a year ago and reducing pressure on local GPs.

With 42% of all referrals received going to our Child and Adolescent Mental Health Service (CAMHS), this service has been where we’ve seen the biggest improvement. Referral processing time for non-urgent referrals has gone from 13 days to just eight days in our first six months with the SPA.


Service user feedback

• “I looked at the website, I found it to be easy to navigate, information was easy to find, as when you put in what you wanted it came up with a menu of choices.” Parent.
• “It’s much better. I like the pictures and it’s a lot easier to work with.” Professional.


In many cases the triage process has also allowed us to flag more urgent referrals which hadn’t been identified by the referrer as urgent, and allow us to offer early help support and advice more quickly – reducing risk, admissions to Accident and Emergency services and costs to the health economy.

Our service users have told us we’ve improved their experience of our services – and referrers are pleased that people now get to see the right service first time without any fuss.

What’s next?

We will continue to develop and improve the service as part of our roadmap, developing additional content for the interactive website and new features as we learn more about how people want to access our support.

In 2016, we’ll begin to develop content for young people written by young people making it easier for our younger service users to understand the difficulties they face, the support we offer and what the future might hold.

We’ll also add more than 30 more self-help guides for families and professionals to use with more minor difficulties, or while waiting for treatment to begin to collect important information which our clinicians can use to provide better support and we’ll continue to refine the information we provide on referral criteria based on feedback from those professionals who refer into our services.

Try out the website yourself at http://devon.integratedchildrensservices.co.uk.

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