Sarah Prema (Chief Strategy and Planning Officer) and John Singh (Long Term Conditions Adults and Older People Manager) have been invited to the meeting to provide an overview of services commissioned, specifically relating to this topic area.
Members previously indicated that they wished to have details of budgets and budgetary trends, comparative data, the processes involved and the monitoring of performance. Members will be asking questions on these topics and other areas of interest in order to gather evidence for the review.
Minutes:
Sue Locke, (Chief Operating Officer) and John Singh (Long Term Conditions Adults and Older People Manager) attended the meeting to provide an overview of services commissioned, specifically relating to this topic area.
A copy of the presentation to the Commission is attached for information.
The following comments were made during the presentation in addition to the comments contained in the presentation:-
a) The CCG commissioned services at all 5 steps of the Stepped Care Model and NHS England commissioned some specialist services at Step 5 as well.
b) The programmed spend by Leicester City LPT/CCG on Core Mental Health had dropped in recent years as some funds for specialist commissioning had transferred to the NHS England.
c) The spend was, however, above the national trend for this expenditure and was on par with Derby CCG but below Nottingham CCG on weighted spend per head of population.
d) West Leicestershire CCG led on contract monitoring, finance and qualitative performance. This was monitored by the Finance and Technology and the Performance Committees. These Committees had representatives of all 3 CCGs in Leicester and Leicestershire had GPs on them.
e) The 3 CCGs spent approximately £80m on mental health services.
f) The targets for commissioned services were found in the Outcome Frameworks for NHS, Adult Social Care and Public Health and also in the contracts and KPI’s for local providers.
g) Mental Health was a priority work stream within the Better Care Together strategy. The CCG was working with GPs so that services could be more responsive to changes in local communities.
h) The Liaison and Diversion Services had led the way in a national pilot initiative.
i) Although there was no specific commissioning of mental health services for young black British men, all commissioned services were available to all parts of the community and could be accessed by young black British men. More work was required to understand why this group were not accessing the services available. There was a balance to be struck between commissioning services for specific groups and commissioning universal services that were accessible by all.
Following questions from members the following comments and observations were made:-
a) The voluntary sector provided services for health, counselling and advocacy through Adult Social Care commissioning and a list of the bodies that provided these services at Steps 1-4 could be supplied after the meeting.
b) The funds transferred to NHS England filled the apparent gap in funding Core Mental Health Expenditure since the CCG was established in 2013.
c) The CCG Board receive monthly reports on attempted suicides of patients in hospital and patients ‘out of stay’ and the length of stay of patients. The CCG had raised some concerns with the LPT prior to the CQC initiating their inspection of the Bradgate Unit.
d) Equality Impact Assessments (EIA) were undertaken for all new service provision and these would also be undertaken for initiatives under the Better Care Together programme. EIA’s were not always easily accessible from previous health bodies which were no longer in existence.
e) The CCG had used a portal in a community ‘voxpop’ to capture views on services and it was recognised that there was still more to do in this area.
f) The CCG worked closely with GPs in all areas of the City and listened to specific issues that may be emerging. Any proposed responses to these issues would be assessed in relation to outputs/benefits and gains to the population in order to maximise the use of limited budgets and resources.
h) National feedback on population changes was behind local information on population changes. GPs were a useful resource in identifying changes in population movements or identifying specific issues within a particular community. For example the influx of new communities such as the Somali community in recent years or different cultural approaches to lifestyle issues such as alcohol within east European communities. The CCG would also discuss with GPs the health impacts upon the system and what could be undertaken to address these.
i) Some communities showed a prevalence for only accessing services through A&E facilities because primary care services were not prevalent in their country of origin.
j) IAPS service showed that GP and locality based services were responsive to patients needs and more needed to be done.
k) CAMHS was a key stream in the Better Care Together programme.
l) Network4Change had been involved in the Crisis House consultation process which had led to the pilot scheme being introduced to see if it should be a helpline, a bed based facility, a drop in centre or an open house facility.
m) Communications on services were conducted jointly with providers through the communications engagement team.
n) The CCG used a wide variety of monitoring methods to provide feedback on issues of concern and take up of services. These included:-
· Public Health data which could show hospital activity generated by difference communities or groups.
· GPs IT systems were also use to analyse activity by the coding of conditions.
· GPs identified clinical needs to the CCG which were then assessed to determine priorities.
· Locality meetings were held with GPs, practice nurses, practice managers and receptionists etc provided a wide range of feedback. These meetings were held monthly in each area of the city, and also included training and discussion on new initiatives. If practices did not attend the engagement team would visit the practices to ask why and to ensure that they got the information they had missed.
· There were a number of clinical leads for health issues, e.g diabetes which also helped to inform on priorities and best practice.
· The engagement team also liaised closely with community leaders.
· There were specific ‘tweet’ groups to keep people informed of their interest area.
· Groups with specific conditions e.g COPD had been invited to open meetings to discuss services and attendees have ‘voted’ on their preferences for service provision.
o) As the Mental Health Partnership developed its strategy it would consult various interest groups etc and would need to ensure that those taking part were representative of the issues involved and not just the core organisations involved in health delivery.
p) The Better Care Together Programme was currently being developed and as it went through the various stages it would be considered by the various democratic processes in all partner organisations.
Members of the Commission made the following observations:-
a) The issues facing young black British men have remained the same for the last 30 years. Numerous surveys and research have been carried out during this period, which have consistently shown that the issues still remain the same.
b) A comparison was drawn with the specific measures that were introduced in relation to HIV and there may be a case to introduce specific targeted measures to reduce the issues for young black British men.
c) Use of social media methods should be widely utilised to engage with young people and to seek their views, comments and complaints on services, as they were less likely to use traditional methods to communicate these to statutory or formal bodies.
d) Communications should be an essential element of commissioning services if it was to be successful. Evidence suggests that including communications as part of the commissioning process, ensures that elements of communication are considered at, and embedded in, all stages of the commissioning process and, as such, both the service and the communication of it, were more successful than if communications was dealt with at the end of the process when the service had been shaped in isolation to any communication issues it might involve.
The Chair thanked Sue Locke and John Singh for their participation in the meeting.