The West Yorkshire Complex Rehabilitation Programme (CRP) was established in 2019 with a clear mission: to enhance the care offer for the significant population of service users placed in locked rehabilitation. Historically, these individuals have frequently been placed far from home for prolonged periods of time, reporting "loss of hope", “feeling excluded" and "forgotten". Through comprehensive consultations with the service users and their carers, coupled with rigorous data analysis, regional stakeholders agreed that there was an urgent need for new clinical pathways and invested in the CRP to deliver these. The aims were simple – to ensure the safe and effective repatriation of service users, closer to their homes and to use the learning to enhance the performance of the whole system across the domains of quality, process and cost.
By 2020, the programme launched the first clinical pathway: the Community Rehabilitation Enhanced Support Team (CREST). CREST is a pioneering initiative for the region, comprised of registered mental health professionals working side-by-side with peer recovery support and coproduction workers from the third sector to one clinical model – ASCEND™. ASCEND™ was collaboratively designed with multiple stakeholders to facilitate clearer progress in care and empower service users and teams by ensuring there was a transparency to the clinical offer at different stages.
By adhering to one clinical as well as operational model across the diverse population, this provides new opportunities to make progress in several areas. These include ensuring patient centred care has greater clinical continuity across settings, tackling variation and inequitable access, and supporting accountability.
To realise the core aims of the programme, CREST collaborates intensively with inpatient and place-based teams, forging a shared understanding of the rehabilitation journey for a service user. CREST spearheads the interactions across settings in order to progress the pathway. The approach has structure: one example being the preparation to discharge phase (inreach), lasting up to 12 months, which initiates transition far earlier than usual and so can address barriers more effectively. CREST provides intervention across multiple settings as the service user moves towards greater independence in the community. This consistent engagement has cemented robust relationships between CREST, service users and providers. Reporting on this progress and being transparent with challenges has been instrumental in fostering trust, consolidating achievements and encouraging progressive strides in rehabilitation at a service user, team, programme, and regional level.
From its inception in 2020, CREST initially served three West Yorkshire areas: Leeds, Calderdale and Kirklees. By 2022, this expanded to encompass Bradford and Wakefield, marking CREST’s holistic engagement across West Yorkshire and the opportunity to embed a true regional approach.
Stepping into 2023, the learning from CREST’s development offered valuable insights to the region, which were regularly shared with regional stakeholders. The learning included that service users in locked rehab settings required objective reviews of their care to support more accurate forecasting of need. There was a clear demand for new solutions serving those with specific mental health presentations. Simultaneously, there were implications for CREST from the growing demand to prevent avoidable admissions. In response to ongoing regional stakeholder consultation, the programme refined its objectives, which now are:
1. Continue and extend CREST provision, introducing annual Enhanced Clinical Reviews for all individuals in locked rehab settings.
2. Expand CREST’s services by commencing a dedicated pathway for individuals with complex emotional needs.
3. Develop and embed collaborative strategies for commissioning inpatient beds in West Yorkshire, specifically for those with complex rehab needs.
4. Engage with regional partners and stakeholders in crafting a strategic plan for step- down supported accommodation, tailored for those with complex rehab needs.
Developing CREST – a brief timeline
June 2019 The Complex Rehabilitation Programme established core aims by holding an extensive consultation period acquiring perspectives from service users, carers and wider stakeholders on the current situation and desired future.
Sept 2020 Recruitment commenced for initial pilot.
April 2021 CREST established as a pilot scheme in Calderdale, Kirklees and Leeds.
December 2021 CREST developed and implemented the ASCEND™ clinical model in collaboration with service users, carers and wider partners.
April 2022 Pilot extended to include Wakefield and Bradford in response to data illustrating the significant impact of CREST on successful transition and discharge into the community. Key features were improvements in quality of life, and previously unseen substantial periods of gradual stabilisation outside inpatient settings despite extensive histories of readmission and fluctuating risk in the community.
February 2023 The Complex Rehabilitation Programme held a regional stakeholder workshop, evaluated all progress to date, and agreed CREST should convert from pilot to full project with adaptations to the core aims (see above).
February 2024 CREST celebrates the soft or informal, launch of its CEN (Complex Emotional Needs) pathway. It has reached this milestone thanks to the dedication and hard work of its team and collaboration with a wide range of partners since 2021.
CREST serves people from Bradford, Kirklees, Calderdale, Wakefield, and Leeds and has been regionally commissioned to reduce use of Level 2 settings (formerly known as locked rehabilitation) and support greater independence for individuals closer to their homes.
Over the past two and a half years, CREST has:
Supported over 20 discharges from Level 2 inpatient settings into community placements, serving a population of men and women over 18 with severe mental illness and associated problems related to multiple or extended use of inpatient services.
- 19 of these service users have sustained ongoing community placement without requiring inpatient readmission, crisis or criminal justice services.
- Established a comprehensive multi-disciplinary team incorporating specialist roles in substance misuse, family support, practice development, dietetics and third sector peer support and recovery.
- Implemented the ASCEND™ clinical model, providing specialist transition-focused input aimed at community repatriation and admission prevention.
- Integrated psychologically-informed practices and co-production in both clinical delivery and service development.
CREST built on its learning from its original pathway, Severe Mental Illness, (SMI) and leveraged both the clinical/operational processes and vibrant stakeholder relationships to lead to the current soft launch of the new pathway within CREST, specifically designed for service users with complex emotional needs - CREST-CEN.
Key features of CREST-CEN include:
- Tailored delivery to meet the unique needs of this specific user group, mirroring the broader offer of CREST.
- The soft launch phase where the team work with a pre-identified group of service users in Level 2 settings, clinically reviewed in 2022-2023. The full launch, anticipated in Q1 and contingent on ongoing recruitment, will expand to include new referrals and those at risk of Level 2 setting placements.
CREST-CEN, with its focus on addressing Level 2 usage, will work closely alongside, rather than replace, existing services for complex emotional needs, like colleagues within EMERGE in Leeds and York Partnership Foundation Trust and trauma-informed pathways within South West Yorkshire Partnership Foundation Trust and Bradford District Care Trust. Going forward it will utilise the existing clinical and operational governance processes within LYPFT Eating Disorders and the Rehabilitation service line and WYMHLDA board to provide relevant updates.
The programme and CREST-CEN team expressed gratitude to Leeds and York Partnership Foundation Trust, South West Yorkshire Partnership Foundation Trust, Bradford District Care Trust, CREST SMI, wider stakeholders, and the service users and their families who have been instrumental in the development of this new pathway.
For more details see Complex rehabilitation and CREST; West Yorkshire Health & Care Partnership (wypartnership.co.uk).
For enquiries please contact:
- Clinical Lead: Ashley-christopher.
fallon ,@nhs.net - Medical Lead: Julie.
hankin4 ,@nhs.net - Clinical Operation Manager: jeanette.
lawson ;@nhs.net - Complex Rehab Programme Manager: complexrehab.
lypft @nhs.net
Our work with service users
Co-production is at the heart of CREST’s work and is not an empty word. It means we work together with service users and carers to make decisions about their care.
Talking closely to service users and carers has given us a better understanding of their needs and how we can improve their care and quality of life. Acting upon their recommendations means that among other things:
Co-production will start at the earliest stage possible so that service users are involved in decision making which affects them at the very outset.- Service users have informed decisions made about staff recruitment and training.
- Service users will receive more support for vocational planning and how to access educational opportunities to help with the transition process from hospital.
- Service user voices will always inform the work bridging the gap between inpatient rehabilitation and community provision.
Co-production recognised for national award
Tristan Batten, Peer Recovery Support Lead, previously Co-Production Lead, was a finalist in the "Lived Experience in Leadership" category at the National Service-User Awards, hosted by Cygnet Healthcare.
Dr Ashley-Christopher Fallon, Clinical Lead for CREST, said: “Coproduction is at the heart of the West Yorkshire Complex Rehabilitation Programme, and Tristan, working closely with other leaders in the programme, has demonstrated a fantastic breadth of skill and tenacity in bringing forward the service user perspective to influence both compassionate clinical delivery as well as trauma-informed service development. This has involved everything from co-developing patient rated experience measures and delivering powerful presentations at board level, to hosting cake and chat groups in inpatient wards.”
He added: “Tristan has not only demonstrated high levels of enthusiasm, compassion and patient centred focus, but has deftly included contributions from his own lived experience across many layers of development which has inspired service users in this population to believe they have hope and opportunity with recovery as their view is represented.”
Our work with all partners
Service users, carers, staff members and wider partners are routinely consulted and included in the Complex Rehabilitation Programme developments. The commitment to transparency goes across all levels and to achieve this a framework of meeting spaces exists to provide clear communication to all partners. This provides opportunities for reflection and comment on progress to date, the potential for innovation, and importance of consolidation.
These spaces include the ICS/Partnership meeting which unites the five places to work together on programme aims and service user and carer spaces across inpatient and community settings. Significant work achieved with partners has included the creation, implementation and review of the ASCEND™ clinical model, and expansion activity such as establishing the newer CREST Complex Emotional Needs pathway. For the latter, this has featured reviewing and sharing clinical stories with coproduction leads and place-based leaders to inform design and delivery, and the seemingly smaller but equally important activities such as creating trauma-informed leaflets and consent forms.
Carers’ comments on family support input from CREST have been very positive and the benefits of this have been a source of hope for them. Carers also noted the positive benefits they saw when they felt engaged with a hospital and with the wider network of professionals who work with their loved one. It has been described as very supportive in that it was educational, practical, and bespoke to family and individual family members’ own needs.
Both service users, carers, staff members and wider partners report similar themes around communication. CREST is committed to listening and providing feedback, and partners report that through the process of CREST providing time to discuss cases that places feel understood and involved in the outcomes.
The programme acknowledges that carers can be just as important to a service users’ recovery as the clinical teams which support them, and that carers should be supported and treated as partners in the care system. A range of actions support this, including:
Advocacy support for carers- Placements in hospitals as close to families as possible
- A better information flow for carers
- An open culture that looks to learn from mistakes, crises and incidents.
In November 2020, the Complex Rehab Programme as part of the West Yorkshire Health and Care Partnership published two reports outlining the lived experience of people from our region. The project team reviewed the care and experience of 103 people in 23 hospitals, engaged with people and carers in person, and anonymously reviewed plans of care and levels of need. The reports can be viewed using these links:
Dawn Hanwell, Chief Financial Officer & Deputy Chief Executive and SRO for the programme, Leeds and York Partnership NHSFT, writes:
“It is CREST’s focus to lead and support the work that services across West Yorkshire provide for people who are often left many miles from their homes, and help to bring them back to their communities. This means that the quality of their experience is enhanced by the difference we can all make working together and with our service users.”
Dr Ashley-Christopher Fallon, Clinical Lead, Complex Rehabilitation Programme, writes:
“CREST is making meaningful strides as part of the wider Complex Rehabilitation Programme to accelerate the journey nearer home for people with complex mental health problems. It is truly rewarding to be an active part of strengthening relationships between the five places in West Yorkshire, independent hospitals, step-down providers, and other agencies to collaboratively move the shared vision forward. Stakeholders from across the service users, staff and provider groups all report that transparency and a ‘can do’ attitude influence much of what the programme is achieving.”
The Leeds and York Partnership Health Foundation Trust is the lead provider for the CREST programme and hosts it on behalf of the West Yorkshire Integrated Care Service.
You can read further about CREST at https://
Opportunities
Interested in working in mental health? Passionate about recovery and improving outcomes for those living with serious mental illness and complex emotional needs? We may have just the job for you at CREST, our Community Rehabilitation Enhanced Support Team. Working across the West Yorkshire region, we pride ourselves on helping people to step down from long-term hospital placements to supported living.
We’re looking for motivated and enthusiastic individuals who want a new challenge. We want empathy, positivity and hope. In return you will be able to work intensively in a rewarding role. Watch this video to find out what working with CREST is really like for our dedicated staff.