Agenda item

Leicestershire Partnership NHS Trust submits a joint report with Leicester City Council to the Public Health and Health Integration Scrutiny Commission on Adult Mental Health Services, including the key challenges, waiting times and partnership working.

The Lead Commissioner of Mental Health at the ICB and managerial and clinical colleagues presented this report. It was noted that:

·       Last update was 12 months ago.

·       The report has been transparent on the challenges currently faced by the services. There have been increased pressures on all services and neurodiversity is where the most significant challenge has been.

·       The employment service provided has been a good news story with over 1000 patients able to retain or access employment, including paid employment.

·       A challenge has been the psychiatry waiting times. The transformation programme has continued to be prioritised, as well as testing out new roles and pathways to work towards enabling people to have their first needs led assessment within 4 weeks from 1^st April 2025

·       Perinatal mental health target is 10% for Leicester, Leicestershire and Rutland. Based on the birth rate in this area, it equated to about 12,000 women. In August, the service was on track to hit the target by the end of the March 2025. A significant amount of work has been done with maternity services and GP’s to promote access and referrals.

·       ADHD has been a particular challenge, but this has also been reflected nationally. A business case has now been drafted which has explored other potential funding options. Currently, non-recurrent funding from Leicester City Council has been used to recruit for supporting treatment commencement.

·       Adult and older adult memory service had reported challenges post-covid. There have been weekend clinics to support people accessing their diagnosis through a range of appointments and a one stop shop was piloted to reduce the number of return appointments.

·       The dementia diagnosis rate in Leicester has been above the national average and is something the service has been very proud of.

A brief outline was provided of 3 of the psychology services in the community provision:

·       There are 7 therapists and one service lead providing Cognitive Behavioural Therapy. This has had unprecedented numbers of referrals. Despite this, the service has managed well as it has continued to provide assessments within the 13-week period, but it is has been under huge pressure.

·       To help prevent service users being bounced between services, an integrated strategy has been introduced. There has been work with colleagues in Vitaminds and central access points to ensure the right people have been referred to the right services. Nearly 40% of those referred for CBT haven’t been appropriate.

·       There has been an improvement in recruitment in the psychodynamic service. Whilst there have been longer waits, these have been for very specialist interventions. The average waits have remained steady.

·       There have been longstanding challenges for personality disorders. A significant amount of work has occurred and this has now been reflected in the majority of services users being seen within 13 weeks for their first assessment. This is a huge improvement but is still not considered quick enough.

·       The current model has not been delivering the range of interventions needed by this population, so work has been done to develop a more appropriate offer.

·       A number of services come under the urgent care pathway including the Mental Health Central Access Point, the Crisis Resolution and Home Treatment Team, the Mental Health Urgent Care Hub and the Mental Health Liaison Service.

In response to questions and comments from Members, it was noted that:

·       Vacancies in the service have included advanced clinical practitioners, particularly with specific ADHD training and pharmacists. Additional training has been identified for community pharmacists so they can provide ADHD medication.

·       The perinatal and dementia target rates have no relationship to diagnosis rate.

·       Perinatal inpatient care was commissioned for the region and is based in Nottingham. The team have worked closely with them to ensure there are good pathways.

·       The waiting list for children who have been referred to see a clinician is currently 3 years.

·       Locally there are waiting times of 3.5 years for assessments and 4 years for treatment but in other areas this can be 10 years. It has been hoped there will be some national funding due to the scale of the challenge and it would be hard for any ICB to fund. The ICB has committed to a proportion of the business case.

·       Pre covid there was about 40 referrals a month, there has now been 400 a month.

·       The Right to Choose scheme offers another route, and can choose ot go private however there is no guarantee of quality. If there is no shared care provider agreement, the patient would also be expected to cover the cost of the prescription, some of which are quite costly.

·        Personality disorder and dementia waiting lists have been decreasing.

Agreed:

·       The Commission thanked officers and noted the report.

·       To be added to the work programme for spring 2025.