S12 Solutions: Supporting the mental health crisis care pathway from point of referral for Mental Health Act assessment to admission to hospital

The issue:

When an MHA assessment is required, the appropriate local authority AMHP service will be contacted. The AMHP reviews the person’s background information, establishes if they are known to mental health services, contact the people involved, and attempt to identify the person’s nearest relative. They then search a list of section 12 approved (s.12) doctors/registered doctors to support the assessment process.

Sourcing the appropriate doctor(s) to undertake the assessment is often challenging especially if the individual has a need requiring specialist knowledge such as a learning disability (LD) or they are under the age of 18. It is best practice for the AMHP to seek a doctor who knows the patient in a professional capacity (doctor with previous acquaintance), or who specialises in a specific area e.g., LD, Child and Adolescent Mental Health Services (CAMHS), Older Persons or Adult Psychiatry.

Assessment organisation, and the process doctors use to claim payment for attending assessments in some cases, are completed using paper-based processes. AMHPs often use paper lists of doctor’s details to arrange assessment, which are not necessarily up to date or accurate. AMHPs may not have full access to the entire s.12 doctor network, relying instead on a small number of known doctors to contact.

Once appropriate doctors are identified, a suitable assessment time needs to be established when both doctors are available. This searching and seeking process can take several hours, which means a patient can be left waiting for long periods, often in distress; in the emergency department, in police custody, or in the community – with the delays having an impact on the wider crisis care pathway.

The paper claim form process can lead to absent, duplicate or slow payments for assessment doctors (deterring them from s.12 work) and the many types of form are not necessarily GDPR compliant. Doctor approval status is not routinely checked – AMHPs and doctors may unintentionally breach human rights by unknowingly arranging unlawful detentions. These factors make services vulnerable to time-consuming, difficult and costly legal challenges and compensation claims.

S12 Solutions is the first innovation to approach this challenge differently, and has received support from Wessex AHSN’s Health Innovation Programme and the Mental Health Innovation Support Programme.

What we did:

Wessex AHSN’s Director of Industry and Innovation connected with S12’s founder at the 2018 NHS Expo and invited her to apply for the AHSN Network Health Innovation Programme (HIP), a four day start-up course to develop the value proposition.

The Health Innovation Programme provided an opportunity for the founder with her background as a social worker to consider and develop the essential elements of growing the innovation commercially and to hear from successful past HIP graduates.

Wessex AHSN supported S12’s preparation for their successful NHS Innovation Accelerator (NIA) and Innovation and Technology Payment (ITP) applications. The founder was accepted onto the NIA programme for their 2019 fellowship. S12’s successful application to NHS England for the Innovation and Technology Payment (ITP) Evidence Generation Fund enabled additional sites and employees to be funded, plus investment in infrastructure and evidence generation.

Wessex AHSN offered innovator support and evaluation expertise, undertaking an independent evaluation to demonstrate the impact of the first S12 Solutions platform across Hampshire and Southampton.

An implementation support guide was also produced, based on lessons learned, providing useful information to other sites looking to implement S12 Solutions. This also enabled the local organisations to understand how the innovation worked in practice and the potential impact on front line care.

Wessex AHSN has also carried out a workforce evaluation in collaboration with Kent Surrey Sussex and Oxford AHSNs.

Wessex AHSN’s innovator support and evaluation teams continue to provide advice and services to S12 Solutions across the innovation pathway.

What impact did it have?

• S12 Solutions are working with around 75-80% of mental health trusts in England and the platform is live in over 50% of the country, supporting around 6,500 users.
• The outcomes from the Wessex evaluation formally verified the feedback received from S12 Solutions’ implementation sites, and also gave new sites the opportunity to bring the evaluation into their business cases. S12 are currently spreading the innovation across the UK and internationally.
• People needing assessment under the Mental Health Act are now reviewed by a team that understands their needs in a more timely way, giving the MHA team more time to focus on the person being assessed.
• S.12 approval is now checked automatically via a link to the Department of Health and Social Care Mental Health Act Register database, reducing the risk of unlawful detention
• Registrations of doctors and AMHPs on the platform is high, as is their satisfaction with the streamlined claims process
• Fewer phone calls, text and emails are needed to arrange assessing teams; the evaluation of the S12 Solutions pilot in Hampshire and Isle of Wight Sustainable Transformation Partnership (HIOW STP) in 2020 showed more than 3.5 hours of admin time saved for every 50 claim forms processed
• Governance is improved, with patient and staff data now more secure.
• The S12 Solutions team has grown from 2 people in 2018 to 26 people in 2020.