Safehand Case Study - OneLondon

Through the OneLondon eMHA programme, a new digital tool has been introduced in London to support safer, faster and more joined-up care for people detained under the Mental Health Act (MHA). 2024 saw Safehand Consulting work with six mental health Trusts via the OneLondon eMHA programme to ensure that this new approach, using a digital platform to access, record and share information, was compliant with DCB 0160.

Background

The MHA sets out the legal processes used to assess, treat and detain (if necessary) in a hospital or community setting, people with mental health conditions, often without their consent, to ensure their safety or the safety of others.

In most parts of London, the process for assessing and treating people under the MHA has relied on different staff from different organisations completing and sharing a number of paper-based forms. eMHA by Thalamos supports quicker and more joined-up assessment, treatment and discharge of Londoners detained under the MHA, and OneLondon has supported the deployment of the software in a regional, pan-London programme to improve the experience for patients and clinicians.

While each Trust was required to complete a bespoke safety evaluation under the DCB 0160 Safety Standard, it was recognised that there was an opportunity present for the risk assessment to identify the common themes and implementation measures that would be required across all six organisations.

Safehand provided a Clinical Safety Officer (CSO) to work on behalf of OneLondon to lead a Clinical Safety Workstream, with participation from all six trusts, overseeing the clinical risk management process for the project.

Objectives

  • Facilitate compliance with DCB 0160 at six NHS Trusts involved with the programme
  • Conduct safety analysis that identified the foreseeable hazards associated with implementing eMHA across the capital
  • Evidence the implementation of safety measures where they were provided by the pan-London programme
  • Evidence the implementation of the controls that could only be addressed by the participating Trusts themselves
  • Produce robust documentation that sets out this systematic approach to clinical safety at both a regional and local level, including a Clinical Risk Management Plan, Hazard Log and Clinical Safety Case Report, and six Deployment-Specific Appendices

The approach

Planning

The risk assessment was planned at a pan-London level, drawing on project documentation relating to the OneLondon programme combined with an engagement process to ensure representation and involvement of the participating Trusts in developing the Clinical Risk Management Plan (CRM Plan).

The CRM Plan identified that:

  • Hazard identification would take place in a pan-London approach, with two discovery hazard workshops to draw on the experiences of the full range of multidisciplinary team members involved in the application of the Mental Health Act.
  • That each Trust would be responsible for the approval of deliverables and acceptance of clinical risk associated with the deployment.
  • That some clinical risk would likely be mitigated by measures being taken at the programme level, and that these would be set out within the main body of the Clinical Safety Case Report (CSCR).
  • Clinical risk management workshops would be held at each Trust to consider the localisation work required to implement the remaining controls.
  • Evidence of implementation of these localised controls would be set out within a Deployment-Specific Appendix, to accompany the CSCR.

Implementation

Following approval of the CRM Plan by each of the participating Trusts, work throughout the summer of 2024 included the initial discovery workshops and the development of a Hazard Log setting out the identified clinical risks, their causes and the necessary mitigations required for safe use of eMHA by the NHS.

The CSO worked closely with the supplier and the OneLondon team to ensure that the required controls identified informed the work undertaken across the programme. This meant that where possible, controls were implemented at a level which would ensure the greatest reduction in risk, and greatest efficiency, for the programme as a whole. This work captured the clinical risk management activity undertaken at a regional level and was documented within the main CSCR.

In the autumn, the focus shifted to supporting the individual Trusts with their implementation work; ensuring that the safety activity that could only be undertaken at a local level (such as the development of Trust Standard Operating Procedures) were complete and evidence of their implementation was documented. Each Trust had regular access to the CSO to support their programme of work.

Hazard workshops at each Trust identified the local factors that influenced their individual deployments and ensured that their safety assessments accurately reflected the unique circumstances of each organisation.

Outcome

  • A Clinical Risk Management Plan that identified an approach that could both deliver economies of scale and risk management that was reflective of each participating Trust’s needs.
  • A Hazard Log setting out the reasonably foreseeable hazards, their causes and associated controls, with material included to account for the varying use of system functionality and different circumstances at each of the participating organisations.
  • A Clinical Safety Case Report setting out the work undertaken regionally, accompanied by Deployment-Specific Appendices evidencing the localised safety work at each Trust.
  • Further ongoing support for the programme through the establishment of a Clinical Operations Group responsible for conducting clinical risk assessments of further change management of the product, the monitoring of clinical risk in live service, and shared learning between participating organisations.

OneLondon’s view

Working with Safehand Consulting has been positive and supportive. The OneLondon eMHA programme was complex - spanning multiple NHS and social care organisations, all working together to digitise the Mental Health Act. Safehand provided well-planned, pragmatic, thorough and very professional clinical safety oversight and delivery for OneLondon. We recommend their highly skilled and expert guidance and the positive working relationships that they established.

Safehand genuinely works with you, ensuring clinical safety compliance is achieved and embedded. They played a vital role in helping us introduce the new digital system that is now supporting safer, faster, and more joined up mental healthcare in London. Thank you!

Joss Palmer, OneLondon Programme Director

Leading this work has only been made possible by having experts on hand to deal with specialist areas. Safehand has brought the necessary expertise and managed all the detailed aspects of Clinical Safety. It has been a pleasure to work alongside Alex.

Nina Schmidt-Marino, Head of Digital Strategy and Planning London Region NHSE; Pan-London lead for OneLondon eMHA programme