The Core Study


Waltham Forest case study

NELFT Home Treatment Services are based at Sunflowers Court, Goodmayes Hospital, where all our inpatient wards are located. Following the centralisation of Acute Services, closer interaction with the ward and HTT on a regular basis was enhanced. 

Gatekeeping is a fundamental role of a crisis service. In NELFT, various systems had been trialled but it was felt that when admission was recommended it was necessary to more clearly outline what the purpose of the admission was and what was expected to change once the admission occurred. At the point of admission, an Early Discharge Facilitation / Admission plan is utilised to specify what the purpose of the admission is and what is expected to change following the admission. 

Once admission occurred, it was also felt that robust systems were required to ensure that gatekeeping occurred at both ends of the spectrum; at the point of admission as well as at the point where home treatment involvement was warranted, as the risk profile allows. 

A structure was therefore developed where an HTT staff member attends the respective wards (borough based) daily and is part of the 09.00 Run through where plans for the day are laid out and actions are agreed to address delays in discharge.  

This system works particularly well as HTT forms an integral part of the ward team and plans are followed through consistently. In order to support this further, the HTT Clinical Leads and team manager also attend the 09.00 Run through to support the process and address any complex delays / wider system interface issues. 

A weekly bed management meeting between Acute and Community services Leads addresses delays in discharge from the ward and further promotes Whole System working.