Have Your Say on Mental Health Services in Nottinghamshire

Recommendation 1: Prioritise early intervention to reduce waiting times and provide information on ‘waiting well’: We recommended that the Trust and wider partners look into addressing the issue of waiting times, not only in terms of reducing the time for assessments, diagnosis and treatment, but also in communicating better on waiting times to service users and supporting them while they wait. This could include providing guidance around how to wait well (i.e., providing material on coping mechanisms that may be useful) and signposting service users to services that they could access in the interim. 

Progress reported by the Trust: A Waiting Well procedure is now in place, providing clear guidelines on the process for managing people on waiting lists, including how often they will be contacted and what additional support is available while they wait. A Patient Tracker process has been introduced for people waiting for assessment and treatment by community mental health services, demonstrating proactive engagement with patients. Oversight is reported through senior leadership and board-level performance monitoring. Internal processes for managing early intervention services have been updated. 

Recommendation 2: Examine and improve the way in which patients are identified to receive care from Primary Care Mental Health Practitioners, especially for those with long-term mental health needs: We recommended that the Trust work collaboratively with wider partners, ICB Place Based Partnerships, Primary Care Networks, and Primary Care practitioners to enhance the Primary Care offer. This should assist in triaging patients more effectively, reducing referrals to incorrect services, and ensuring the receipt of timely support from appropriate services. 

Progress reported by the Trust: A Primary Care Interface Group has been refreshed and a Complex Case Panel established. A Shared Care Record (Notts Care Record) is now in use across Nottingham GPs, bringing together information from across various aspects of health and social care. Mental Health Pathway Redesign Workshops involving GPs and partners have also been introduced to support service redesign. 

Recommendation 3: Streamline the referral process and ensure that services are accessible to all: A key focus of this recommendation was the reduction of lost and/or missed referrals. We recommended the Trust ensure that technology works consistently across services, to prevent referrals being lost due to files corrupting or being transferred in incompatible formats. We also highlighted the need to improve technological solutions to support and centralise the storage of service users’ notes. 

Progress reported by the Trust: A Digicare Programme is now in place to drive forward digital transformation across the Trust, including optimisation of Electronic Patient Records, Electronic Prescribing and Medicines Administration, the Notts Care Record, and referral management. 

Recommendation 4: Implement centralised, co-produced, ‘person-centred care plans’ to support consistency in care and ensure all service users receive holistic, person-centred support: We recommended that, as far as possible, there should be consistency in the clinician(s) involved in an individual’s care, and that a centralised document such as a person-centred care plan should exist from the outset, with a timeline and key information to inform a service user’s treatment and support. 

Progress reported by the Trust: A Personalised Care Policy is now in place, covering safety planning, risk assessments, care planning, and safe discharge. 89% of Community Mental Health Team staff have completed aligned core training. The Trust has implemented DIALOG, a patient-led assessment tool co-developed with people with lived experience, which supports the development of personalised, co-produced care plans. An updated supervision policy now includes structured review of patient care plans during supervision sessions. 

Recommendation 5: Invest in more services to holistically support service users, such as those offered by The Recovery College and Voluntary, Community, and Social Enterprise (VCSE) organisations: We recommended that the Trust ensure all support provided is holistic, including getting to know a person beyond their condition, and signposting or referring individuals to services that address their wider needs. VCSE organisations were praised throughout the project for offering timely, holistic, person-centred support in welcoming environments, often led by culturally competent staff with lived experience. We recommended the Trust learn lessons from the voluntary sector and consider investing in more VCSE organisations to support service users, whether while on waiting lists or as a complement to structured treatment plans. 

Progress reported by the Trust: Over 80 peer support workers are now in place across the Trust, providing lived experience roles within the workforce. A Peer Worker Plan has been developed with the aim of offering peer support at every stage of a person’s journey and across all services. 

Recommendation 6: Ensure that service users are given information regarding their condition(s), particularly following their initial formal diagnosis: We recommended that professionals take time to discuss an individual’s diagnosis and any prescribed medication with them, to ensure they understand what it means for them and how it may impact their day-to-day life. We also recommended that organisations like The Recovery College provide a wide variety of courses covering a range of mental health conditions, and that all service users are signposted to appropriate services, charities, and VCSE organisations wherever possible. 

Progress reported by the Trust: A Personalised Care Framework and Delivery of Personalised Care Policy are now in place, with a focus on shared decision-making, offering accurate information on care and treatment options, and connecting people to community-based support through social prescribing and link workers. 

Recommendation 7: Review the current crisis provision with the dual aim of improving services and increasing the public’s awareness of crisis services: Due to the mixed feedback received regarding crisis services, we recommended that the Trust review its crisis provision across the City and County to identify what works, where there are issues, and any solutions and training opportunities. We also recommended the Trust improve public awareness of crisis provision, including crisis sanctuaries, eligibility, locations, and how to access them, and provide clear communication to patients on who and where to contact in different scenarios. 

Progress reported by the Trust: A significant programme of work has taken place to review and improve the Crisis service, including the Crisis Access Line. An improvement plan is in place with monthly improvement meetings. The Trust is working with NHS England to ensure crisis provision meets the needs of the people. 

Recommendation 8: Ensure that any further service evaluations engage with a sample that is representative of service users and the local population : We found that the 2022/23 review featured a certain demographic profile (predominantly White women), and highlighted the need to consider whether there are inherent biases, cultural barriers, or demographic factors, including gender, age, and language, that may prevent certain communities from engaging with specialist mental health services. We recommended the Trust review and mitigate this disparity in any future commissioning and service evaluations. 

Progress reported by the Trust: The Trust has committed to embedding the Patient Carer Race Equity Framework (PCREF), with a two-year action plan published on their website. The framework is designed to address racial disparities in mental health services and ensure care is equitable and culturally responsive. 

PCREF information: https://www.nottinghamshirehealthcare.nhs.uk/iev-pcref 

Action plan 2025–2027: https://www.nottinghamshirehealthcare.nhs.uk/pcref-action-plan 

These are the Trust’s own reported updates. Our survey now seeks to understand whether the changes described above are making a real difference to the people who use services day to day.