Agenda item

This report aims to provide members with insight into the range of available mental health services delivered for Hammersmith and Fulham residents and to improve opportunities to understand care pathways, and to provide a snapshot referral demand and service challenges.

6.1           Councillor Richardson welcomed Dr Chris Hilton and Helen Mangan from West London NHS Trust (WLT) and additional contributors which included Lisa Redfern, Jo Baty, Dominic Conlin and Dr Barbara Cleaver.  For ease of reference, Dr Hilton shared slides based on the appendix attached to the report.  He briefly outlined the remit of the Trusts work which encompassed the provision of forensic, high secure specialist local services.  The report focused on a broad range of provisions and borough related demographics as precursor to further reports to the committee. Dr Hilton outlined key points about individuals who wanted to access services and the volume of demand and the WLT response and how the Trust was positioned within the framework of the Integrated Care Partnership (ICP).

6.2           The PCN raw data indicated that there were currently 7409 H&F residents accessing local mental health services, of which 534 were receiving support from the WLT dementia services. WLT was working to improve access to services amongst particular cohorts and the appendix indicated a breakdown of service use by different PCNs. The access and entry points to the various services included walk ins and self-referrals.  The data indicated that access during the pandemic decreased significantly with a fall in activity across many services.  Going forward, Dr Hilton reported that there was long term planned investment to create opportunities to improve services such as CAMHs. Neurodevelopmental services including Autism and ADHD (Attention Deficit Hyperactivity Disorder) were not provided by WLT in H&F but was offered by Chelsea and Westminster Hospitals NHS Foundation Trust (ChelWest) and the Cheyne Child Development Centre. A mapping exercise across North West London was currently underway to identify the range in provision for adults with autism and ADHD to try and improve local pathways. Dr Hilton also highlighted aspects of the 24 hour liaison psychiatry crises services at Hammersmith and Charing Cross hospitals (full details of the presentation are accessible at 44:53, H&F Health, Inclusion and Social Care PAC | 10 November 2021 - YouTube).

6.3           Dominic Conlin advocated the development of a collaborative approach which offered an opportunity to reposition autism and ADHD services.  Integral to this more holistic approach with earlier intervention was the relationship with acute mental health services.  Commenting on the activity following lockdown there had been a notable increase in the volume and acuity of patient presentations. He highlighted two aspects: first, that patients who did require inpatient admission had significant wait times, often in unsuitable environments; and that this became fragmented if admission was required prior to transfer.  A joint approach was preferable to support paediatric mental health services which included early intervention enhanced by improved training, development and digital innovation.  This would offer better support for staff in identifying patient symptoms.  

6.4           Dr Barbara Cleaver explained that A&E departments were under significant pressure and seeing large numbers of patients presenting during a mental health crises with high acuity of need.  Approximately 5-8% of patients with complex needs waited for more than 12 hours in A&E for a mental health assessment.  A deep dive had been carried out to understand how mental health assessments could be conducted. Dr Cleaver commented that she’d experienced some difficulties in accessing out of hours mental health professionals.  It was agreed that the Local Authority would meet with her urgently to address this. Charing Cross hospital had enhanced the space provided for patients in A&E to ensure that it was safe, appropriate and kind for patients experiencing a mental health crises.  Dr Cleaver thanked H&F for funding provided to support recently completed work on a mental health garden which had been financed through crowd funding and Hive initiatives. 

6.5           Councillor Richardson welcomed the approach at ChelWest and asked how easy it would be to implement this.  This was an ambitious plan, but one supported by as an acute trust which recognised the benefit of simplified and more responsive pathways for people to navigate. 

6.6           Councillor Lloyd-Harris welcomed the report and referenced paragraph 4.9, and that of 76% of referrals, 16% came from GPs.  She asked what assumptions WLT was making about the increased activity and if this could be attributed to the lack of direct access to GP practices.  A second question sought clarification about the percentage figure of unanswered calls, so whilst some people may have waited on hold, others might have redialled. A third question was about the physical barriers presented by Covid restrictions to in person contact that remained operational.  Mask wearing in a one to one session presented a barrier, particularly for children and adolescents.  Dr Hilton responded that self-referrals were encouraged, and that WLT was keen to make the Improving Access to Psychological Therapies (IAPT) services as accessible as possible in line with national targets.  There had been a large media campaign to encourage people to access services at the beginning of 2021 and the referral figures could be attributed to this. Key to improving access was working closely with primary care givers.  In terms of a single point of access a sophisticated call handling system was in place. This presented a comprehensive picture and WLT followed national guidance on call waiting times: 24% of calls were completely abandoned and further information about this would be provided after the meeting.  With regards to in person contact, patients visiting healthcare premises were required to wear masks although staff were not expected to comply with this. However, measures to respond to any escalation or new wave of the pandemic remained in place. 

6.7           Councillor Richardson briefly provided an overview of issues raised about the report and the data provided which she invited members to further elaborate on. It was difficult to evaluate progress using the data as it did not allow for baseline comparisons.  The quality of the demographic data required greater granularity.  Ethnic monitoring categories were broadly homogenised with little regard to diversity. The ethnic grouping with highest number was “other” which did not offer reliable data.

6.8           The demographic data was difficult to interpret as categories were broad.  Jim Grealy queried the use of the term “elderly” within the report and broad categories for disability and ethnic groupings. Improved metrics that reported figures rather than percentages offered better context which was important in visualising barriers to service provision and usage, similar in form and content to that provided by Imperial College Healthcare NHS Trust.  Merril Hammer clarified that percentage figures were difficult to understand without the raw, baseline figures.  Dr Hilton accepted that the Imperial format offered improved insight and that this would be made available in future reports.  The brief for the report had focused on demand for services and in response, a data commentary had been sourced from service directors, managers and clinical leads. He acknowledged that the lack of performance detail was frustrating, however this was published in the WLT integrated performance reports and showed that the organisation was meeting its targets. Addressing the unhelpful use of blunt ethnic monitoring categories, Dr Hilton concurred that there were inherent difficulties, but that monitoring was based on NHS England national coding.  He confirmed that the Trust was committed to improving its understanding of ethnicity in the provision of and access to services.

6.9           Jim Grealy welcomed this response and added that the progress of WLT was unclear from the report.  At a time when many trusts were working in response to Covid, and in anticipation of the forthcoming ICP and greater collaborative planning of resources it was helpful to understand mental health provision across NWL and how this integrated with the day to day, front door service provision of the acute trusts. It was difficult to evaluate WLT without baseline performance data. Dr Cleaver responded that Charing Cross Hospital had a positive interface with WLT with regular, weekly progress meetings, with mental health leads.  The “mental health big room” discussed all matters that related to mental health, including patient centred pathways. Imperial as an acute trust worked with WLT and Central North West London (CNWL), in addition to WLT on the St Mary’s site. Monthly comparative performance data was analysed and senior operational leads, together with Imperial’s operational director, used this to drive service improvement.

6.10        Jim Grealy stated that it would be helpful to have a visual representation showing how decision making intersected in the allocation of resources between different organisations. Dominic Conlin welcomed the governance arrangements and formal levers described by Dr Cleaver and highlighted the differences between acute trust mental health programs and multi-borough provision by WLT, with the main sense of focus being placed based provision.  One of the outputs of the ICP would be to map out areas of work alongside the types of services and impacts that were being made. 

6.11        Dr Hilton felt that some of the points raised would become clearer as the form and structure of the Integrated Care System emerged.  While there was shift away from CCGs the key relationship with the local authority, as governed by shared areas of Better Care Fund (BCF) section 75 commissioning and provision of services, would be integral to the newly evolving system. It was also clarified that the main interface between the acute trusts and mental health providers was the urgent care board covering NWL.  Dr Hilton referred members to section 7.4 which looked at the emerging collaborative place based borough work which would examine differences in provision, what worked well in one area and not in another.

6.12        Jo Baty highlighted the work of the ICP mental health campaign which had progressed well and provided an opportunity for coproduction which was particularly evident through the borough’s work on the dementia strategy. Resident stakeholder involvement was essential, and this would be similarly reflected in the work on developing the borough’s autism strategy.

6.13        Councillor Coleman welcomed the open discussion with WLT which indicated progress, greater transparency and a willingness to engage.  He said that WLT had long been disconnected from the health and care services within the borough and their positive response to the challenges raised highlighted the importance of working together more closely and the greater integration of services that was expected to come.

6.14        Councillor Richardson endorsed the involvement of residents and acknowledged the central importance of engagement and coproduction in shaping the borough’s services. In drawing the discussion to a close, Councillor Richardson briefly recapped on highlighted key areas discussed and considered for future reports such as the importance of service mapping and data, the inclusion of local demographic data, CAMHs, transition to adult mental health services and the ICS.  In particular the MINT report would cover financial, strategic and operational issues. It was also important to include learning from Covid and how this influenced engagement and coproduction.

ACTIONS:

1.          Improved access to out of hours approved mental health practitioners as raised by Dr Cleaver would be explored  and resolved with Jo Baty, assistant director outside of the meeting.

2.          WLT to share a link to performance details;

3.          WLT to provide further information about the 24% of calls that were abandoned;

4.          WLT to bring more focused performance information on H&F to future meetings, beginning with the next report on Mental Health Integrated Network Teams (MINT) in January 2022;

5.          WLT to provide operational and performance information in relation to MINT report to be presented at the next meeting of the committee; and

6.          WLT to explore the use of ethnic monitoring categories with business intelligence colleagues.

RESOLVED

That the actions and report were noted.