Protecting the delivery of mental health services in Greater Manchester

“If anything, people’s need for talking therapies and this kind of intervention increased,” explains Dale Huey, Associate Director of Psychology at GMMH. “Social isolation, disruption to normal ways of coping and normal social support, increased threat to livelihood and self-esteem and the general sense of the physical threats of COVID-19 meant, by and large, people’s difficulties were exacerbated.” 

Ensuring vital services continue to run

Even a Trust like GMMH, with its history of technology leadership, needed to adapt quickly. Its early adoption of Windows 10 had helped to protect the Trust from the disruption felt in 2018 in many other parts of the NHS that was caused by the WannaCry ransomware hack. Now, its decisions to standardise on Microsoft Surface devices and to begin trialling Microsoft Teams in August 2019 looked equally prescient. 

Anticipation of a lockdown announcement meant the original plan to roll out Microsoft Teams VoIP from December 2020 was brought forward. In the wake of the sudden need to enable staff to operate from home and the need to ensure service users could still engage in their treatment, the Trust’s gold command structure made the decision to expedite the Microsoft Teams roll out. This decision was made easier by the existing estate of Microsoft Surface laptops and tablets.

A security first approach for the long-term

“We knew Zoom was not something we could support because of the security issues and we had already ruled out Attend Anywhere,” explains Grace Birch, Associate Director of IM&T at GMMH. “Since we knew Teams would be our solution going forward, leadership recognised the importance of not diluting our capacity to roll out. The team really stepped up to the plate: we realised the challenge and our part in that and stepped up and delivered.”

Huey admits, “Perhaps oddly, from a clinical perspective we felt incredibly lucky. That work had been done proactively enough for us to have a relatively smooth transition.”  

Modernising communication tools

Psychological therapy (IAPT) is GMMH’s largest service and it was most eager for remote working capabilities. It delivers talking therapy support for people with mild, moderate, and moderate to severe symptoms of anxiety or depression. 

Around 5,000 people were accessing face-to-face IAPT meetings in March when, almost overnight, the Trust found itself no longer able to offer those services. “We moved from 10,000 in-person appointments per month to holding them all remotely via Microsoft Teams in two weeks,” remembers Huey. “We have Microsoft Surface devices, so we can easily work from home. We began using the VoIP functions at first, then gradually moving to Teams video. The brilliant Surface display is great for video calling.”

Microsoft Surface enables secure cloud management

Digitalisation and the switch to remote working is not only about rolling out the right communication and collaboration solution. The Trust’s IM&T team was also busy getting devices out to clinicians and support staff, so they could work from home. Plus, they needed to ensure they had the right infrastructure in place to enable that massive growth in remote working.

GMMH had standardised on Microsoft Surface Pro several years earlier and its ICT estate includes some 2,500 Surface Pros. This helped to streamline the switch to Microsoft 365 and Microsoft Teams. Microsoft Surface gives users the freedom to work from any location without compromising control and security. Managed by Microsoft Endpoint Manager and the Device Firmware Configuration Interface (DFCI), seamless management is enabled to the firmware and component level with just a few clicks through the cloud.  

“There are many technical reasons for choosing Microsoft Surface but our vision has always been that people should need only one device,” reflects Andre de Araujo, Head of ICT at GMMH. “The Surface Pro does this: it can replace a desktop, laptop, tablet – a mobile phone, even. Plus, people like using it. The drivers are all inherent which makes it nice and easy. You know everything you rollout is going to be compatible and you have Microsoft support.”

Support for user adoption

GMMH reached out to Microsoft for adoption and change management support, drawing on expertise in the Microsoft Customer Success Unit and using Microsoft Store to support end user training/education and adoption.

GMMH ensured the transition was supported in each service by a super user who would be a first point of technical support for clinicians and staff, filtering queries to the ICT team and sharing knowledge. IAPT Performance and Data Quality Team Systems Officer Matthew Kerrigan took on this role for the IAPT service, tasked with supporting 400 new users. 

“Supporting everyone in using a product like Microsoft Teams in which you have real faith and enjoyment makes this challenging task far less so,” reports Kerrigan. “The ability to screen share with someone who is struggling and actually show them how to do something speaks a thousand words. To run a training session for clinicians now will simply mean inviting them to Microsoft Teams.”

Good engagement supports the progression of therapies

Although the technology adoption went smoothly, there were other cultural issues to address. Eighty-five percent of IAPT clinical staff had not been trained to work remotely, so the service also needed to support staff to work with complex problems in a new way. “We had a staff group who was feeling massively deskilled,” explains Huey.

Additional support was offered through virtual drop-in sessions to talk through experiences, access to advice from experts in telephone-based therapies and by using Microsoft Teams to share the contemporaneous materials being released nationally. A knowledge team was created to share tips such as how to share files, how to keep numbers anonymised, and how to use a whiteboard.

IAPT then moved quickly to survey clinicians and service users about the acceptability of delivering services in this way. “We looked at acceptability in terms of engagement, trust and making progression, for example,” says Huey, “and, by and large, clinicians and clients had positive and equally matched views. Getting this positive feedback from clients really helped clinical staff in terms of their confidence.”

An evidence base of acceptability and effectiveness

The service is now moving on to conduct a further survey to measure the effectiveness of the new way of working. Early work by IAPT Performance and Data Quality Team Systems Officer Matthew Kerrigan shows a 4 percent drop in cancellation rates since switching to Microsoft Teams video conferencing. 

“We’re trying to establish our own evidence base around acceptability and effectiveness,” continues Huey.  “I think there is a lot of potential in the more consistent use of video as the main means of interfacing with people. And there’s an element of increased creativity through increased familiarity with its use.”

For example, since much of the service’s work centres on promoting self-management, the co-construction of ideas is a key part of therapies. The fluidity of sharing materials and using a whiteboard within Microsoft Teams greatly aids this approach.

Enabling teamwork anywhere with Microsoft Surface Hubs

During the same period, GMMH invested in a number of Microsoft Surface Hubs. These were used to enable a new way of working and to conduct critical meetings. The multi-disciplinary team meetings which used to take place in person, could now be conducted virtually using the powerful meetings and collaboration platform that is Microsoft Teams-certified.

With some staff located at the Trust headquarters and others joining the meeting virtually, the Microsoft Surface Hubs provided a sense of focus and togetherness and enhanced the collaborative ambiance of MDT meetings during lockdown. The Trust adopted a similar approach for its COVID-19 command and control meetings; using the Microsoft Surface Hubs to facilitate hybrid in-person/virtual planning discussions.

A permanent change to service delivery

Moving forward, the Trust can now offer more choice to clients. The ability to access care without having to traverse the busy city region to reach a clinical location will make accessing support more comfortable for many service users battling anxiety-related issues, avoidance or depression.

“We want to make it as easy as possible for people to attend appointments, especially the first appointment,” says Huey.  “I don’t think we’ll ever go back to providing services the way that we used to; a remote option will always be part of the offer.”

This change also offers new potential for GMMH to drive cost efficiencies, helping to minimise the overheads of maintaining clinical locations and physical presence across the region.

Fit for the future

While the pandemic has presented major challenges for IM&T, the need to deal with change at this pace has also brought benefits. Birch says, “This has absolutely been a partnership between IM&T and clinical services. Those relationships have developed further and will stand us in good stead going forward.”

The GMMH IM&T team is already looking at further innovation. It plans to extend its roll out of Microsoft Windows Virtual Desktop (WVD) to increase accessibility and flexibility for remote working. The continuity between WVD and Microsoft Surface Pro has been a huge benefit, especially for those people working in the field over the mobile network.

Birch says, “I think we have only skimmed the surface of the power that we have within the product. We’re now looking at how to make sure we’re as flexible as possible and can enable service users to access services in the way they need to.”

Work to move all clients to Microsoft 365 is stepping up and the Trust is moving all shared file services into Microsoft Teams. De Araujo explains, “We won’t have any on-prem file shares, so users will be able to use all the indexing and search functionality and collaboration tools and the integrated tools of PowerApps and Microsoft 365. Our use of Microsoft Surface devices makes this a seamless experience for users and easier to manage for us.”