Medicine Information Service for Healthcare Professionals

Community transformation

INTRODUCING A NEW COMMUNITY MENTAL HEALTH SERVICE MODEL

South West London and St George’s NHS Mental Health Trust (SWLSTG) are in the process of transforming their mental health services and changing the way they operate in Kingston and Richmond. This is in line with the NHS England Community Mental Health Framework for Adults and Older Adults, which describes how the Long Term Plan’s vision for a place-based community mental health model can be realised, and how community services should modernise to offer whole-person, whole-population health approaches.

The transformation programme runs over three years, with the first year taking place in Sutton, as the pilot. Over the last 12 months, teams in Kingston and Richmond have worked closely with local stakeholders – GPs, Voluntary, Social and Community Enterprises (VCSEs), the South West London Integrated Care Board (SWL ICB), local authorities, service users and carers – using learning from the Sutton pilot to design and implement this change.

SWLSTG has worked with service users and carers to design a new model of care, centralised around the core principles of community transformation:

• Improved integration with VCSE partners
• A placed based holistic support offer
• A “no wrong door” approach to referrals
• Introduction of new roles and skillsets
• Single, trusted assessments
• Removing barriers between primary and secondary care.

These core principles underpin the work to achieve the four key outcomes of transformation:

• Access – increased timely access to a wider range of mental health interventions
• Recovery – increase in the number of people reaching and maintaining recovery
• Crisis – reducing the risk of service users relapsing into crisis
• Experience – improved experience of care and treatment in mental health services for service users, their carers, family and friends.

NEW SERVICES

As part of Community Transformation, each borough has established a Single Point of Access (SPA) team, offering holistic mental health and wellbeing assessments with a focus on service user and carers’ needs.

Following assessment, a multidisciplinary team collaborate at daily referrals meetings to establish the most appropriate interventions based on identified needs and goals. This exciting new service development helps to speed up the referral process and achieves greater integration between primary care, secondary care and VCSE partners.

Through attendance from a range of professionals, service users and carers can access a wide range of mental health, physical health, wellbeing and socio-economic interventions within newly developed integrated Recovery Hubs (formerly Recovery Support Teams (RSTs) or Community Mental Health Teams (CMHTs).

The holistic services provided in Kingston and Richmond now include:

• Tailored mental health care and treatment, which may include dedicated support for Complex Emotional Needs, support through an expansion of psychological interventions, increased pharmacological treatments and the introduction of further support for co-occurring mental health, alcohol and drugs
• Employment Support to help individuals to retain and obtain employment
• Newly commissioned peer support services provided by VCSE partners, which provide peer support from individuals with lived experience of mental health conditions, offering support, guidance and sharing experiences to help individuals with their recovery goals and needs.
• A forthcoming newly commissioned welfare advice service provided by VCSE partners, offering assistance with issues such as welfare benefits, housing and finances
• For our partners in General Practices, the SPAs also offer specialist Advice and Guidance without the need for referral through the e-referrals (eRS) system.

In line with our new integrated model, the following teams will change to Integrated Recovery Hubs (IRHs):

• North Kingston CMHT will become North Kingston IRH
• South Kingston CMHT will become South Kingston IRH
• Richmond RST will become Richmond IRH
• Twickenham RST will become Twickenham IRH

The SPAs and IRHs are not crisis services. If the service user is having pervasive thoughts of ending their life which they feel they will act upon, then this should be treated as an emergency. They can telephone the 24h Mental Health Crisis Line on 0800 028 8000, attend their local Accident & Emergency (A&E) department, telephone the emergency service on 999, or telephone the Samaritans on 116123.

Overseas visitors

Overseas visitors who need healthcare while in the United Kingdom may not be entitled to free healthcare from the National Health Service.
 

We understand that your visit to our hospital may be very stressful for you and we would like to make it as easy as possible when it comes to your understanding of the information that may be required by our staff to establish entitlement to NHS services.

This page details our overseas visitor management and what can happen when you arrive at any of our sites. The How to access NHS Services in England  website provides more details.

Who is an overseas visitor?

An 'overseas visitor' is any person who is not an 'ordinarily resident' in the UK. To be considered ordinarily resident, you must be living in the UK on a ‘lawful and properly settled basis for the time being’ –  you may be asked to prove this.

A person is not ordinarily resident in the UK simply because:

• they have British nationality
• hold a British passport
• are registered with a GP in the UK
• have an NHS number
• own property in the UK
• or have paid (or are currently paying) National Insurance contributions and taxes in the UK.

Since April 2015, non-EEA nationals who are subject to immigration control must also have Indefinite Leave to Remain (ILR) in the UK to be ordinarily resident in the UK.

What that means is that if you are visiting the UK as a tourist, on business, to stay with family, living in the UK without proper permissions, or if you are a British citizen but not settled in the UK, you may have to pay for the hospital treatment you receive. Depending on how urgent the treatment you require is, you may be asked to pay in advance.

What is SWLSTG’s legal obligation?

The Department of Health charging regulations place a legal obligation on NHS trusts to establish whether a person is an overseas visitor to whom charges apply, or whether they are exempt from charges.

To carry out these assessments, contact the Overseas Visitors department who specialise in assessing patients to establish whether a patient is liable for charges or if an exemption applies. This may involve asking the patient to provide documents to prove or support entitlement. Patients who are assessed as not entitled to free care will be required to pay for their treatment and will be asked to pay a deposit on account.

Immediately necessary or urgent care will not be withheld based on ability to pay even though they remain liable for the treatment cost.

Non-urgent or elective treatment – We are required by law to withhold treatment from chargeable overseas visitors until the estimated full cost of the service has been paid. This decision will be based on clinical opinion.

It is the responsibility of the patient to provide evidence, when requested, to demonstrate that they are entitled to free NHS treatment. When evidence is not provided, treatment will be charged for.

What will happen when I arrive at the hospital?

All patients will be asked to provide acceptable supporting evidence to prove their entitlement to free NHS care – one evidence to prove identity and another to prove UK residence. The Overseas Visitors Team will advise you of the type of evidence that may be required depending on your circumstances.

What are exemptions that may apply?

There are some treatments which are free irrespective of your overseas visitor’s status. These services include appointments at your GP, treatments in the A&E departments, under Court Order, Mental Health Act etc. The Overseas Visitors Team will advise on the specific exemptions that apply to you.

What do I need to do?

If you are visiting the UK from the European Union (EU) and European Economic Area (EEA) member states, you are strongly advised to bring a valid European Health Insurance Card (EHIC) with you from your home country and present it to the staff at your appointment as this proves your entitlement to receive emergency, urgent and immediately treatments. Your EHIC card does not cover treatments for pre-existing conditions and routine treatments that can wait till you are reasonably expected to return home except when delaying the treatment will make your condition progressively worse. But you can present your S1/S2 Forms which will allow you access planned treatments. Read more information for Visitors from EEA or Switzerland.

If you hold a passport from the countries that UK has reciprocal health agreements with, you will be entitled to receive any treatment that cannot wait until you can return home and provided you did not come to the UK for the purpose of seeking treatment.

If you are a student, you will require an EHIC card (EEA students only), a copy of your Passport and Visa, Biometric Residents Permit (BRP), or proof of travel insurance to cover your whole stay in the UK. We will also require a letter from the UK school, college or university you are studying at confirming that you are on a course there, and whether it is a full or part-time course, how long it’s for and also confirmation of your attendance rate.

If you are from a non-EEA country and have paid the Immigration Health Surcharge as part of your visa application or are exempt from paying, you will be entitled to receive free NHS care.

It remains your responsibility to satisfy the Trust of the validity of your claim to free treatment but sometimes, when there is uncertainty, the Trust may contact the Home Office to determine this.

If we confirm that you are not entitled to free NHS care, you will be asked to sign an 'Undertaking to Pay' form and pay the estimated cost of your treatment and when your treatment is deemed to be planned or elective, we will expect to receive the full cost for your treatment before it commences and if payment is not received, your appointment might be cancelled.

Where can I get more information?

If you have any questions, please contact our Overseas Visitors Team:

T : 020 3513 6109    E : OverseasTeam@swlstg.nhs.uk   

You can also visit the Department of Health & Social Care Overseas Visitors pages: NHS Visitor and Migrant Cost Recovery Programme