Agenda item

Janet Cree, Managing Director, NW London CCG and Jane Wheeler, Deputy Director, Mental Health Strategy and Transformation Team, NW London CCG, presented the case for change, which used an evidence-based model for care.  This had been produced following investigated planned change and the business case scheduled for later this autumn and it was envisaged that this would also include feedback from forums such as this one.  Jane Wheeler continued that there was good practice evidenced across the boroughs. Bringing this to the PAC meeting for the first time, Jane Wheeler explained that there was a whole system strategy, which set out issues and challenges but they aimed to make change happen locally. 

The single point of access, 24 hours a day, seven days a week, was central to having this service, with referrals from LBHF, local agencies and the Police, although she advocated early interventions that would pre-empt the need for Police involvement.  There existed good services on which to build upon and the Mental Health Team Strategy (MHTS) local targets reflected national targets for 2020.  With regard to the graphic on page 89 of the report, it was noted that the single box provided a useful framework highlighting priorities.  Focusing on eating disorders (work stream for April 2016), this was just one of several work streams which had been previously endorsed. 

The overall aim of achieving a holistic support system in place was to ensure continued improvement in the quality of care for those with Serious and Long Term Mental Health Needs (SLTMHN).  It was explained that people were reviewed in different parts of our system.  They should be identifiable on discharge and picked up by other parts of the service, as appropriate.   Achieving integrated transformation across social care was necessary to achieve an integrated approach.  The impact on service users and carers in LBHF would be to simplify care journeys, making it easier to access services that emanate from a single point of contact.

In responding to a query about beds not being available and the alternative service options in that scenario, how this would really work in terms of service change and whether this was the right configuration to rapidly access services, Janet Cree outlined that the CCGs were pleased to engage closely with local services provided by organisations such as MIND and Mencap, which they viewed as critical friends.  Councillor Brown congratulated them on the report, which he felt did much to challenge the stigma surrounding mental health and to ensure that these were addressed with equal assurance as physical issues. 

Patrick McVeigh briefly outlined the case of an acute patient who was a manic depressive and had committed suicide.  Enquiring about monitoring methods, in the borough, this had not been picked up until the Coroner’s Enquiry.  Jane Wheeler explained that sharing data was possible but there were inherent difficulties in suicide prevention that made it very difficult to share data.  In this case, there would have been a time lapse in receiving the data from the Coroner’s office.  Dr Robinson added that although these numbers were relatively small, it did not preclude learning points being identified.  Patrick McVeigh enquired what the actual number of cases were and it was agreed that the data from the Coroner’s office could be shared.

ACTION: H&F CCG

Bryan Naylor commented that within an aging local population, it was hard to identify mental health needs before they became acute.  There was a need to work more closely with services to address the fear that many older people had about illnesses such as Alzheimer’s or dementia.  He highlighted concerns about obtaining diagnosis and early intervention.  Jane Wheeler accepted that this aspect of social isolation needed to be addressed and would form part of the Sustainability and Transformation Plan (STP).  Citing Brent as a good example of this practice, she explained that there was a NW London steering group meeting to address this, consisting of local community groups, working throughout the local community to support themselves and the wider community. Councillor Fennimore commented that this was an important aspect of adult safeguarding work and should form part of the work programme.  The opportunity to meet with members of Age UK to discuss their concerns was accepted.

ACTION: H&F CCG / Age UK

Janet Cree stated that there was joint dementia review being undertaken, working across dementia services, and recognised that there was an issue around post diagnostic support.  She concurred that the focus had been on process and that there was a need to improve the diagnostics in terms of clinical pathways, with a view to redesigning them.  Reiterating concerns by some Age UK members, Bryan Naylor highlighted issues such as memory loss and forgetting words, as being early warning signs and that GPs did not have sufficient time or resources to allay fears.  Vanessa Andreae explained briefly the process by which GPs drew initial conclusions by asking three questions: name and address, time on the clock, and to remember three words given to them at the start of the conversation.  A referral was then made if the answers were inadequate. 

ACTION: H&F CCG

Councillor Barlow referred to the SLTMHN box diagram on page 90 of the report and enquired about the transition of children’s services into the new modal of care.  Jane Wheeler confirmed that this was a long standing issue and part of the work undertaken to address this in LBHF was with the Anna Freud National Centre for Children and Families.  It was acknowledged that there were different points of transition.  In terms of transition services such as out of hours provision of Children and Adolescent Mental Health services (CAMHs), it was noted that the 16/17 age group data was skewed towards young women.  Councillor Barlow commented on the correlation between age and health need, and the resulting impact.  She enquired whether other services within the borough were sufficiently integrated, to identify potential causes such as poor living arrangements.  Jane Wheeler confirmed that they had tried to engage services jointly where children were transitioning, with a view to sharing solutions. 

Highlighting the integrated model of care, Councillor Barlow asked about how information in such cases could be shared, for example, where a patient presents at the GP practice.  It was understood that sharing of patient information between primary and secondary care was a complicated area, although this had improved. 

Councillor Barlow enquired about the eating disorder work stream and what the criteria was.  The requirement to work across boroughs, indicated a need to ensure that they demonstrated resilience to operate in this way, was acknowledged. 

Enquiring about the single point of contact, Councillor Natalia Perez asked about improvements to the referral process, potential first contact and referral pathways in the voluntary sector, with organisations such as Mind and Mencap.  In the case of individuals with low incomes or on benefits, there were inherent challenges in evidencing mental health need.  Jane Wheeler explained that the number of Police referrals was high and not necessarily an ideal way of identifying need.  This was illustrative of the current difficulties that they were seeing and that ideally, they would not want people to be identified through contact with the criminal justice process before accessing the services they needed.  This also concerned raising awareness about how to improve access to services and the sharing of information.  The single point of contact in terms of urgent care response within 4/12 hours of being seen, was a gateway to voluntary sector services. 

Councillor Perez enquired about what the challenges were to the new model of care and if this would reduce the number of beds required.  It was confirmed that there were no plans to close beds although it was noted that some patients did refuse beds, preferring to access services from within the community.  If this provision could be correctly configured, then funding for beds could be diverted to community based solutions.  Responding to Councillor Perez’s point about the lack of availability of local beds and the need to transfer out of the borough, it was explained such a transfer would be counterproductive, resulting in higher re-admission rates.  The aim was to keep people healthy and out of beds and this required tight management on bed numbers.  Liz Bruce confirmed that the Borough did have to find beds outside of the borough, when necessary.  The CAMHs service was highlighted as an example of one service where they were struggling to provide sufficient, long term specialist bed care. 

Janet Cree continued that few referrals were made by sheltered housing associations, illustrating poor sharing of information between housing and social care.  She gave an example where an elderly woman had repeatedly locked herself out of her sheltered housing accommodation and had been subsequently fined.  It was noted that there was a need to improve the existing configuration of services before adding new services, if the whole system was going to work in a conjoined and uniform way.  Councillor Brown endorsed the need for a better interface between health and housing, citing the example of young addict who, following a transfer for treatment outside the borough, had returned to the area and had found it very difficult to be placed in local accommodation. 

Councillor Vaughan enquired about the process of consultation and engagement.  It was confirmed that this had been presented across the boroughs by the collaboration of CCGs and would only go to formal consultation if there were an impact on the number of beds or significant service redesign.  Noting the various actions that had arisen out of the discussion, Councillor Vaughan thanked the presenters for the report. 

RESOLVED

That the report be noted.