Agenda item

This report updates on developments at the West London Mental Health Trust.

The Committee received a report on developments at West London Mental Health Trust (WLMHT), which focused on the following areas:

·         Changes to the management structure within the Trust

·         Progress with Foundation Trust Development

·         Update on the West London Transformation Board

There were two key transformation areas: Urgent Assessment and Care Development and Delivery and Planned Care/Shifting Settings of Care Development and Delivery.

Mr McVeigh queried how WLMHT compared with other parts of London/the country in respect of bed capacity and whether foundation trust status would improve or worsen the situation. Ms Rushton responded that all mental health trusts were seriously struggling, with the exception of East London NHS Foundation Trust.

Ms Rushton did not consider foundation trust status as so important in improving quality of services as the Care Quality Commission (CQC) inspections and Quality Improvement Plans which were very important in embedding good quality at service delivery levels.

Ms Rushton stated that it was her personal view that the freedoms from foundation trust status were not so different, although it would be easier to convert revenue into capital.

Councillor Perez Shepherd queried the different clinical pathways and ways of referral. Ms Rushton responded by giving psychosis as an example. People cared for by the recovery team were often not clear about the interventions being received and what help could be provided at a centre of care. WLMHT was working to develop generic responses and to upskill the workforce in potential interventions. Clearer goals and outcomes would put people more in control of interventions and facilitated measurement of outcomes.

In respect of referrals, people could self refer, although more complex cases tended to be through GPs or sometimes social care.

Councillor Lukey commented that the report did not address a number of issues which would have been of particular interest to the Committee such as what was happening in Hammersmith & Fulham; WLMHT’s relationship with the CCG and Adult Social Care, and specifically the recovery houses; and what worked well and the challenges.

Ms Rushton responded that WLMHT had a good long standing relationship with Adult Social Care in Hammersmith & Fulham and that the relationship with the CCGs had significantly improved over recent months and CCGs were now much more focused on mental health.

A business case was being developed to close in-patient beds and replace with three recovery centres, one in each borough. Currently this did not work financially and there were no suitable buildings. WLMHT was working with the CCGs to resolve the issues.

Ms Mangan referred to Urgent Assessment and Care and the work being overseen by Beverly MacDonald, H&F CCG Clinical Lead for Mental Health. New investment had been agreed and was being taken forward for Hammersmith & Fulham. It was expected that there would be a notable difference in the response to Accident & Emergency patients, which was a particular problem. WLMHT would work in different ways to engage GPs and align primary care services to networks.

Ms Rushton noted key challenges in respect of in-patient service delivery, particularly Section 316 admissions (compulsory detention under the Mental Health Act), including: substandard sites; poor environment; staff understanding of the use of restrictive practices; and the case load of the community teams. Management would remodel  work to care for people within specific times and with specific goals,  and then transfer back to primary care.

Mrs Baillie noted that Adult Social Care was trying to set up a three way session with WLMHT, primary care and the local authorities in respect of changing practices/models of care and was keen to re-establish regular local planning meetings. The new pathways would be focused across the three local services and it was important to have local staff to develop relationships.

Councillor Barlow queried the impact of financial pressures on decisions. Ms Rushton responded that WLMHT was currently in financial balance, but the income for local services funded by the three CCGs was £3million less than expenditure. These services were currently subsidised by other parts of the service, namely Broadmoor which was funded by NHS England, but this money would be required to repay the loan. Work with the new models of care would be financially difficult and CCG funding would be required to make it sustainable.

Councillor Barlow queried how WLMHT would communicate to service users how they would overcome the challenges. Ms Rushton referred to the co-production work with service users. The West London Collaborative had held a number of events for service users and staff. There had been some good feedback from service users and WLMHT had aligned this with their service development plans.

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Mr Naylor referred to loneliness and isolation in the older community, possibly leading to depression and exacerbation of other conditions, and queried what was being done to combat this to prevent increased demand upon services.  Mrs Baillie responded that prevention and advice were integral. The current development advocated lower level interventions at an early stage and working  with local partners and the third sector, including Age UK.

Mr Naylor stated that the third sector reported very rarely being approached by anyone from mental health or social care to address issues except when it came to funding. Mrs Douglas responded that consultation with the voluntary sector had started the previous week with Sobus, development of the commissioning strategy with more local providers.

Ms Domb queried the meaning of co-production in this context. Ms Russell responded that service users were involved from the beginning in the design and delivery of services and referred to the West London Collaborative, which was organising an event in support of the Like Minded Mental Health and Wellbeing Strategy for North West London on Tuesday 22^nd September at the Pimlico Academy.

Action:

Details of the West London Collaborative event to be circulated.

West London Mental Health Trust

Councillor Vaughan summarised the key points of the discussion.

The Committee noted that:

1.    It was encouraging that relationships with other organisations, particularly the CCGs were improving.

2.    There were issues in respect of Accident & Emergency and expansion to 24/7 cover and there was not sufficient urgent care in place.

3.    There would not be a reduction in the number of in-patient beds; closed beds would be used to finance the recovery houses.

4.    There were issues of loneliness and isolation, particularly amongst the elderly.

5.    There were challenges and specifically financial pressures, but also improvements, which it was encouraging to hear.

RESOLVED THAT:

The Committee requested that a report be brought to a future meeting in respect of how mental health and social care were working together with the third sector to agree outcomes and how the strategy would fit with other out of hospital strategies over time.