Complex recovery assessment and consultation team: ensuring patients with complex needs are not stranded in the system


A case study describing work by a multidisciplinary team at Cheshire and Wirral Partnership NHS Foundation Trust to improve patient safety, quality of care and speed of flow throughout the system.

What was the aim?

About 30% of acute mental health patients were becoming stranded because their complex needs did not fit the standard acute care model.

The trust wanted to ensure that no-one lost a day in the community other than for essential care and treatment, and everyone needing an inpatient bed should be in the best bed for their needs.

What was the solution?

The occupational therapy-led complex recovery assessment and consultation (CRAC) multidisciplinary team intervenes on behalf of anyone requiring more than standard secondary mental health inpatient care, to improve quality, patient safety and flow across the whole system.

Tertiary inpatient treatment should be in the least restrictive setting closest to home, and the CRAC team co-ordinates care to ensure discharge at the earliest opportunity.

By providing specialist multidisciplinary team input and a clinical second opinion from a rehabilitation perspective, it enables people to move through the pathway more quickly. The team informs care plans and identifies rehabilitation goals and interventions to support people with complex needs in their recovery and after they are discharged.

The CRAC team developed over several years using quality improvement methods such as plan-do-study-act cycles to refine its service in response to feedback.

Identifying variance in care pathways and monitoring the team's effectiveness were important influences on its development.

What were the results?

  • The trust had few out-of-area acute admission days after 2012 and has had none since January 2016, despite having the fifth-lowest number of acute beds by weighted population.
  • The CRAC team reduced risks of people becoming stranded in acute care: the trust has the third-lowest number of discharges over 60 days.
  • The team ensures regular review of all those in tertiary out-of-area hospitals, helping shape national standards for such work.
  • By avoiding increases in out-of-area tertiary placements, the team has prevented money flowing away from local mental health services.

What were the learning points?

  • Acute patients with complex needs can easily become stranded in hospital.
  • Those in out-of-area tertiary care may be at similar risk, as local mental health teams may find it difficult to identify options most likely to benefit them.
  • Occupational therapy leadership has helped the team work with people with complex needs and multiple co-morbidities, without being too focused on a diagnostic label.

Want to know more?

Please contact Clair Haydon, strategic lead for complex care:

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