3 May 2020

There is increasing evidence that COVID 19 is affecting people’s willingness and ability to seek and access medical care during this time. There is also growing evidence that individuals (including young people) already vulnerable to abuse and exploitation may be even more at risk during this period of reduced support and isolation.

CNWL Sexual Health Services are available to support vulnerable patients and assist professional partners managing and safeguarding individuals during this time.

We would aim to optimise partnership working and streamline pathways between CNWL Integrated Sexual Health Service and our various partner services, agencies and stakeholders in order to better support vulnerable individuals and those in need.

We cannot work in isolation and we recognise the need to work closely with partners to identify and address the needs of the vulnerable groups and maintain the opportunity for service users to maintain good sexual health during this period.

Our services continue to have lots of capacity for telephone consultations and are also able to offer limited face to face appointments and walk-in service for those in need. We will prioritise access to advice, information, testing and treatment to vulnerable and hard to reach groups and the organisations that support them.

If you are currently supporting a client who needs to access integrated sexual health services we offer several pathways.

Young People

  • If you are working with young people (under 18) and they want to access screening, have internet access and a safe postal address then we can advise on how to order a home testing kit.
  • For any young person a routine appointment can be booked for an initial telephone assessment via the central booking office on 0203 317 5252. Appointments are generally available for the same day or next day. If during the course of the telephone consultation a need is identified the young person can then be booked for a face to face review.
  • If young people under the age of 18 attend our services as a walk-in patient they will be assessed and if appropriate will be offered a face to face consultation. This service is not advertised but we will endeavour not to turn away young people needing care.
  • We are sending out an SMS to all registered patients under the age of 18 advising that we are available for help and advice.

Adults

  • For services working with vulnerable adults you can either support them to access online testing through SHL www.shl.uk  or call our central contact centre on 020 3317 5252 who will book them a telephone appointment.
  • If a need is identified we are able to book limited face to face consultations (generally following telephone assessment, but this is flexible). This includes vulnerable adults such as people living with learning disability, mental health issues, commercial sex workers and those living with Domestic Abuse.

If you need any support and advice from the safeguarding team, or would like to refer a young or vulnerable person directly to the safeguarding team please call t 020 3317 5252 9:00 – 17:00 Monday-Friday and ask them to arrange a call back from the safeguarding team. This pathway can also be used if you have a young person that you would like to share information about and facilitate their appointment.

Our team of nurses, doctors and safeguarding advisers are available to offer support to patients and professionals to help patients access appropriate support, advice, screening and treatment.

Please feel free to contact us if you have any queries. We look forward to working with you.

Our Integrated Sexual Health and HIV clinics are located in London and Surrey.

Contact details

A new telephone service goes live on 4 May - the ‘CNWL Check in and Chat’ phone service. 

This is for patients across CNWL who have been advised to ‘shield’ and other vulnerable patients that are self isolating who may want to keep in contact with us. 

We will be using a team of trained volunteers and staff to telephone vulnerable and shielding patients who have been selected by services who need some additional contact to essentially ‘check in on them’. 

This call will come from a volunteer who will use a withheld number that patients don’t know or is different to the service number patients normally hear from.

They will confirm who they are and why they are calling you

They will signpost to services or support within the local community as well as talk to you about any concerns you have and raise them with the service you normally see.

You can also contact the service at cnwl.check-inandchat@nhs.net.

CNWL’s Chief Nurse Maria O’Brien said: “A check in and chat call can make all the difference to someone who is lonely at this time and is a positive step to engage with someone who may have little or no contact with others.

“We are concerned that a consequence of self-isolating may lead to issues with confidence, self-esteem, and loneliness so through this service we hope to identify any practical support a person may require.”

In line with Government guidelines, this service has closed the Adult Hearing drop-in clinics with immediate effect for the foreseeable future. This affects the weekly drop in at Eaglestone Health Centre on Wednesday mornings, the monthly drop-in clinics at Wolverton Health Centre on the third Thursday of each month and the last Friday of each month at Newport Pagnell Medical Centre.

The Adult Hearing Service are no longer able to see clients face-to-face. If you wear hearing aid(s) provided by our service and have problems with these, you can ring the office on 01908 725330 to discuss how we may be able to help you.

If you have experienced a sudden loss of hearing or have concerns about the health of yours ears, please seek advice from your G.P.

CNWL’s talking therapies service in Milton Keynes is continuing to deliver support to patients suffering anxiety and depression despite the lockdown, and they are expanding to deal with concerns raised by the pandemic.

Therapists from the Milton Keynes IAPT Service have started delivering webinars on Cognitive Behavioural Therapy (CBT) skills, techniques and tips to help people who may be struggling with worry or low mood as a result of the current social distancing precautions.

The service normally delivers such webinars in a group setting or face-to-face but following the guidance on social distancing had to think of alternate means of delivering to patients – either new or existing and also to free up resources to cope with an anticipated increase in concerns.

The weekly webinars give suggestions of practical ways to manage your anxiety about Coronavirus and how to cope in isolation.

They are available to the general public by self-referral to IAPT and to health or social care staff in Milton Keynes by registration.

While the webinars are not totally interactive, patients are able to email and receive an answer during the weekly session.

So far it’s proving popular with 18 people attending over the two sessions.

Therapist Marion Barnbrook said: “We know people will need our service so we had to find a way of continuing to provide this service during this really stressful time. We know there will be a demand from people struggling with isolation and this feels to be the best way of delivering to people.”

A survey from the first two webinars had positive feedback.

Attendees said:

  • “I liked the answering of individual questions – it made me feel less like I was passively watching a video, and felt more involved”
  • “I must admit I’m one of the ‘shut up and get on with it’ brigade but I think in this mad world that we are in at the moment, it’s getting increasingly difficult to do that so I’ll definitely encourage my team to join the webinar; might even join again myself just to see it through to the end. I LOVED her ducks  I want some for my house!!!!”
  • “It was fab! There was a link to some documents that she shared which are on the public domain so I’ve shared them with my team and mental health group, who are going to share them business wide. Personally though, I need to recognise when I’m worrying about something and put it aside until my allotted time to worry about them! It’s a useful tool.”

The service is still accepting referrals as normal at this time with telephone assessments continuing as well as planned treatments by phone or video.

For further details go to: https://www.talkforchange.org.uk/  

CNWL will be launching an additional CAMHS Mental Health Emergency Assessment service as part of our 24/7 crisis offer. Based at Northwick Park Hospital, it will divert Children and Young People (CYP) from A&E as part of our Covid-19 response . The service will cover the boroughs of Brent, Harrow, Hillingdon, Kensington & Chelsea and Westminster.

It will be operational from Wednesday 8 April.

·      The service will provide emergency MH assessments, diverting CYP from A&E, signposting as appropriate through existing pathways, and providing a maximum 24 hour stay for patients who may require it. 

  • This will include a 24/7 CAMHS triage process, which will be carried out at point of referral,  Covid-19 and catchment screening by CAMHS practitioners, who will signpost to relevant pathways as needed. 
  • ​CYP without medical need will be assessed away from A&E, either by the relevant CAMHS team during day time or by the new CAMHS Emergency Assessment team at the Northwick Park suite.
  • Any CYP with a medical need will be assessed in A&E by existing CAMHS Urgent Care service which operates 24/7.
  • ​Where CYP are unable to be discharged after assessment because of their mental health needs, they will remain in the suite for a maximum of 24 hours. Placement breakdown or social care issues will not be sufficient need to remain in the suite for 24 hours​. 
  • For non-CNWL/out of area CYP the onsite UCT team will link with relevant locality services and partners to support diversion of the CYP from A&E appropriately.
  • The process for CYP who arrive on Section 136 remains unchanged.

​​

Jackie Shaw and Dr Frances Connan

 

This update provides information about the ways arts therapists have refocused and remodelled community and inpatient arts therapies provision in response to the current COVID-19 emergency. Arts Therapists are focusing on supporting services where resources are most stretched and  supporting service users with highly complex needs and those who may be most vulnerable at this time.

Community Arts Therapies Provision

Urgent Response Arts Therapies Risk Assessment

Arts Therapies services have streamlined provision by designing a new evidence-informed risk assessment tool to prioritise caseloads and ensure that support is maintained to protect those most in need, especially clients with complex needs under our Lead Professional Care and those who are socially isolated with little outside contact.

Tele-Arts Therapies

Arts Therapies services have adapted provision to offer telephone and video sessions where appropriate and have maintained any essential face-to-face contact. Arts Therapies leads have developed written guidance on these tele-adaptations of service delivery, incorporating Trust guidance, to provide governance for effective continuity and treatment.

Long Term Health Conditions

In addition to monitoring any changes in mental health needs and helping people to recognise and respond to any covid-19 symptoms, arts therapists are ensuring people are accessing services and are monitoring long term health conditions to prevent relapse at this time.

Lead Professional Care

Arts Therapists are assisting community mental health teams with their caseloads, taking on lead professional care roles and tasks as pressures on community services increase and the wider mental health provision changes and adapts to the emergency.

Arts and Health Packs

We have developed arts and health packs which have been sent to service users and are being used to support tele-arts therapies. There are a range of ideas that people can use to boost their wellbeing creatively with the resources provided and also weblinks to access arts-based spaces online that will help them connect with others.  The packs also include information and advice sheets for people who may be struggling to manage the ‘stay-at-home’ restrictions and need support with planning their day and accessing necessary services.

Inpatient settings:

Arts Therapists are ensuring that they maintain as much therapy provision across the wards as is possible and working closely with Occupational Therapy and activity co-ordinators on this.

Arts psychotherapies staff are adapting to each ward’s individual needs and have moved to offering 1:1 provision and are thinking creatively around ward arts therapy engagement. Arts Therapists are redirecting some of our provision to support discharge planning at this time and are preparing to upskill other arts therapists further in this area if needed. 

Additional Arts Therapists are being identified to work on wards where there is increased need due to staffing pressures and also utilising honorary staff where possible to maintain therapeutic support. 

Arts Therapies Leads have prepared guidelines to support therapists as they adapt their offer to the wards. This guidance ensures essential measures to combat Covid-19 are observed and sets out the increased range of activities and provision on offer to support the wards at this time. These also take into account the likelihood of staff moving to new areas of work and offer additional induction guidance tailored to different inpatient workplace settings.

Arts Therapists are keen to be an active part of the ward teams in helping the MDT; offering flexible support, clinical guidance and reassurance as the pressures mount for all.  

If you are on prescribed medication from the drug/alcohol service, we will be reviewing and changing your prescriptions so that you do not have to go to the addictions service or pharmacy as much.

For most of you, your keyworker will stay in regular touch and offer support by telephone rather than you coming to the service. There will be no groups running for the time being.

We will stop all detoxes

We will stop taking blood tests and testing for HIV, Hep B and Hep C.

To all stakeholders, service users and carers

Thank you for your continued support and involvement in the Transformation of our Milton Keynes Community Adult Mental Health Services. I would like to take this opportunity to update you all regarding transformation plans during the current pandemic.

Due to the current COVID-19 situation and uncertainty regarding the timescales, it has been agreed with CNWL and the Commissioners that we will be pausing the transformation. This will mean a delay in completing the merging of the Acute Home Treatment Team (AHTT) and Urgent Care Team to create the Crisis Resolution and Home Treatment Team, and a subsequent delay in the development of the community hub. 

We have  prepared a service map to detail how patients and referrers will access services during the COVID-19 pandemic which is attached and we update you as and when this changes. We anticipate leaving Talk for Change as the front door, with Primary Care Plus (PCP) to continue supporting the surgeries that they are currently in.  Obviously this may change with the recruitment of additional staff.  

We have also been able to give additional resource to a number of teams including AHTT, Urgent Care and Hospital Liaison during this period which we envisage will continue, and we are continually reviewing the needs of all our services on a daily basis.

We will continue to keep you informed of the situation.

Lesley Halford, Service Director, Mental Health, Milton Keynes

 

All our Memory Assessment Services have been suspended, and the medical and clinical staff redeployed to other work in the Public Health Emergency.

We know this will be distressing for people waiting and we will bring the service back as soon as we’re able to. Thanks for your understanding.

We are part of the national NHS ‘Improving Access to Psychological Therapy’ service which provides a range of talking therapies for people who feel anxious and worried or down or depressed.

During the coronavirus outbreak we are here to provide support for those who are self-isolating or anxious about the impact of the virus on themselves and their families and loved ones, as well as continuing to provide support for people with problems such as stress, anxiety, depression and insomnia.

To meet the challenge of Covid-19 situation we have temporarily changed the way that our services work. We are mostly offering focused support to people by telephone or video call and for some people the option of online treatments.

If you would like to self-refer to the service  visit: https://cnwltalkingtherapies.org.uk/

Alternatively should you wish to access your local IAPT service via your registered GP practice, you can find your service here: www.nhs.uk/service-search/find-a-psychological-therapies-service/

CNWL as a whole has moved into Emergency Response for the overall needs of the local NHS in this Public Health Emergency.

For mental health services we are opening three ‘Hubs’ ((Mental Health Emergency Assessment Centres)) based at St Charles, Northwick Park and Hillingdon, to support our patients who present to A&E who need dedicated urgent mental health support.

Our Home Treatment Teams and Community Mental Health Teams continue to provide care as usual and will work seven days a week.

Inpatient services remain though The Gordon Hospital, in Westminster (which didn’t have open space or a garden), has closed (see https://www.cnwl.nhs.uk/news/gordon-hospital)

Mental Health patients and carers can still use our Single Point of Access, the 24 hour helpline for Urgent Advice about wellbeing.

We are taking these steps to centralise staffing for the mental health services to:

  • cover for staff who are off sick or isolating due to Covid-19  (over 1000 or about 16.2% of our staff)
  • redeploy staff into other services
  • Enhance emergency services to keep mental crises out of A&E departments.
  • Provide more community services to respond to the mental health need and the additional issues raised (much more anxiety and worry amongst patients and the general public) which our Talking Therapy services will be providing; a direction of travel we think should happen in mental health services in any case.

 

We are still offering face to face meetings to meet essential need but a lot of therapy and care is on line or on the phone to maintain social distancing or shielding of the very vulnerable and for patients who prefer that.

 

Mental health patients will have physical health care provided at a time when they may be mentally unwell too.

 

Health Based Places of Safety (s 136 Suites) remain open at St Charles, Riverside and Park Royal.

 

We know this situation puts a lot of strain on families and we are available to help in these extraordinary times. Together we will get through this. We are the NHS.

 

CNWL has redeployed many Children’s Services staff to other critical services. This is under constant review, in Camden, Hillingdon, Harrow, K&C, Westminster and Milton Keynes for  Health Visiting, School Nursing and Therapy Services; retaining the required workforce to continue to offer services.  

We are offering face to face visits but this is under review; we are also offering contacts through video/ telephone contact (Zoom) to reduce infection risk to both families and staff.

We continue to support children and young people on our Child Protection and Children in Need caseloads in school nursing and health visiting.

Children’s staff continue to find support, advice and supervision through our Safeguarding Team provided virtually using ZOOM / teleconferencing to all staff.

The Looked after Children Teams remain proactive, those who need regular support because of social isolation are being conducted by telephone or Zoom contacts. Initial Health Assessments are being carried out as per guidance.

Children with additional needs and who are under our Paediatric and Therapy teams are being support appointments face to face or through Zoom/ telephone as their needs require.

Zoe Sargent, Associate Director, CNWL Children’s Services, says, “Our amazing Children’s Nursing Teams are continuing to provide contacts with all their families and are providing some additional work, including Intravenous meds to keep children and young people at home and out of hospital at this time.  I am sure you are all aware of the pressure on all services at this time and we will continue to do as much as we can to support CYP and their families during this time.”

We are changing the way some of these CAMHS and Eating Disorders services are delivered whilst the Public Health Emergency continues, this is to provide a service, protecting the vulnerable and reducing the risk of spreading the virus.

CAMHS

Face to face appointments are still offered in our clinics, the majority of existing cases are being managed through telephone and Zoom contacts. 

We have designed a model for a CNWL-wide CAMHS Assessment Hub to operate from Northwick Park to reduce unnecessary footfall in A&E.

This will:

  1. Offer face to face assessment, and manage a standardised agreed admission . admission to a Tier 4 bed will only be considered in an acute emergency.
  2. To ensure diversion of s.135 assessments and s.136 away from A&E.
  3. To provide an emergency assessment space for a maximum of three young people in the hub at one time
  4. To provide an emergency assessment space for a maximum of 24 hours from time of entry to the hub
  5. One bed to be held on Lavender Walk for crisis admission.

Collingham Child and Family Centre will close to inpatient admissions from 27 March 2020. Future admissions if required will be to Lavender Walk. The Collingham team will move to delivering a day and outreach service to manage and treat children and support families to keep their children at home.

Lavender Walk remains open.

Eating Disorders

Inpatient service available. The Day Services are on telephone conferencing and Zoom.  The liaison service continues to support patients to avoid admissions. The plan is to enhance and rapidly develop the intensive community response as outlined in the ED Provider Collaborative approach.

CNWL’s  ECT Service will be operating a reduced service.

The Service will only treat patients at the St Charles clinic on Mondays and Thursdays. We are accepting new referrals.

This is a temporary measure due to the Covid-19 pandemic and the requirement that space be made available for other uses at Northwick Park Hospital.

 We apologise for the inconvenience this will cause, but hope you understand.

Clinic days (Mondays and Thursdays only):  0208 206 7200

We’re really sorry but we are no longer allowing visitors on our wards. This is to help prevent the spread of Covid-19 infection amongst our patients; this has been a difficult decision to make but we feel this is necessary to protect patients.

Visitors will be considered in exceptional and compassionate circumstances, like:

  • for a patient at end of life
  • one regular carer for a patient with additional needs, such as a patient with dementia
  • one parent/guardian for a child

Please speak to the ward manager to consider any exceptional arrangements.

Any visitors who are allowed must:

  • not come to the hospital if you are feeling unwell, including cold or flu symptoms
  • wash or gel your hands as soon as you enter a ward or unit
  • follow the additional measures that will be requested by our staff if you are visiting a patient with an infection.

Staff can download a poster with this information for display here.

Three wards at The Gordon Hospital in Pimlico will be closing from Friday 27 March.

This is wholly related to the Public Health Emergency around Covid-19 and the respiratory crisis in the acute sector.

CNWL as a whole has moved into Emergency Response for the overall needs of the system.

We are centralising mental health services to:

  • cover for staff who are off sick or isolating due to Covid-19  (over 800 or about 15% of our staff)
  • redeploy others to other services
  • enhance emergency services to keep mental crises out of A&E departments
  • provide more community services to respond to the mental health need and the additional issues raised (much more anxiety and worry amongst patients and the general public) which our IAPT services will be providing.

There are currently 23 patients at the Gordon and we have 65 empty beds at other CNWL sites.

The Gordon is also a standalone site and we have others co-located with Acutes (an issue as we anticipate more inpatients will become Covid-19 positive and need care on our wards.)

We also want to use sites that have garden access for patients which will be even more important during this time.

We have moved very quickly on this in the last few days, clinically-led and designed to make this change happen safely.

Staff have been informed and will maintain their grades, pay levels, training plans and receive additional expenses related to any moves.

All individual patients have care plans.

The situation will be reviewed once the Covid-19 crisis has passed but we needed to act now.

https://www.cnwl.nhs.uk/services/community-services/milton-keynes-children-and-young-peoples-occupational-therapy-team

In line with current government guidelines, we have taken the decision to change the way our Thursday drop in clinics operate. With immediate effect, we would advise you to telephone or email us in the first instance if you have concerns about your child’s daily living skills (i.e. dressing, toileting, using cutlery etc.). We will take some details from you or send you a form to complete and then an Occupational Therapist will contact you by telephone or email with some advice/support. If further intervention is needed, this will be discussed with you.

Two community respiratory services across Milton Keynes and London have been suspended and people are being followed up by phone because of the risks to the patient group from the Coronavirus.

The Milton Keynes Community Pulmonary Rehabilitation Service and the Camden Chronic Obstructive Pulmonary Disease (COPD) and Home Oxygen Service have both today (17 March 2020) decided to close following the issuing of new guidance relating to the Coronavirus requiring those at higher risk to reduce social contact.

People requiring pulmonary rehab are in the high risk group.

Patients can contact the Milton Keynes service by telephone on 01908 725001 or by email on cnw-tr.pulmonaryrehabilitation@nhs.net and the Camden service on 020 3317 5355 or email Cnw-tr.respiratoryandoxygen@nhs.net for guidance.

Patients can also refer to this link - https://www.blf.org.uk/exercise‐video - for exercise tips, which has been supplied by the British Thoracic Society.

Both services will remain closed until further guidance is issued.

To minimise non-essential travel for patients we have made the following changes to services

HIV, Hepatitis care and Sexual Health Services.

Guidance on Sexual Health and HIV Services often changes so please go directly to the Sexual Health website - https://www.sexualhealth.cnwl.nhs.uk/.

Sexual Health Services advice as at 30 March 2020

Due to the ongoing impact of coronavirus we are operating a reduced service. You should not come to clinic unless you are told to by telephone or need Post Exposure Prophylaxis (PEP) or emergency contraception.

HIV/Hepatitis advice as at 30 March 2020

Please do not attend the clinic for appointments or tests unless you have been advised by us to attend. All consultations will be by telephone and we anticipate most people can have tests deferred safely.

Please make sure you have at least a 30-day supply of medication and contact us if you have less than this. If someone needs to collect your medication from clinic for you they will need you name and date of birth.

Please see clinic specific advice about appointments and prescriptions by visiting the Bloomsbury (London) or Buryfields and Earnsdale pages.

Currently there is no evidence to say if people with HIV are at higher risk of COVID-19, or of severe disease. The British HIV Association updates their advice on a regular basis: https://www.bhiva.org/Coronavirus-COVID-19