Agenda item

To receive an update on how mental health will be catered for within the proposals in the STP, subject to formal public consultation.

 

Peter Miller, Chief Executive, Leicestershire Partnership NHS Trust and Jim Bosworth, Associate Director Commissioning & Contracting, East Leicestershire & Rutland Clinical Commissioning Group will attend the meeting to make a presentation.

The Commission received an update on how mental health would be catered for within the proposals in the STP, subject to formal public consultation.

 

Peter Miller, Chief Executive, Leicestershire Partnership NHS Trust and Jim Bosworth, Associate Director Commissioning & Contracting, East Leicestershire & Rutland Clinical Commissioning Group attended the meeting to make a presentation and respond to Members comments.  Members were also invited to make comments on the strategy and the principles of what should be included.

 

During the presentation the following comments and observations were made:-

 

a)         The draft STP had little content on mental health mainly because the guidance on preparing STPs was focused on how sustainable systems could be created in 5 years’ time.  The STP focused on the frail and elderly emergency care and prevention in response to the challenges of making the system more sustainable.

 

b)         It was felt that an improved strategy with a stronger emphasis on resilience, prevention and recovery was needed in order to relieve the pressure on the acute mental pathway which was currently under pressure.  The current spend of £100m on mental health services was focused on specialist inpatient type services and more needed to spent in providing support in the community setting.

 

c)         The strategy related mainly to adults, improving resilience and recovery and supporting primary and secondary in-patient and community care to ensure it was timely and robust.  CAMHS was in another work-stream as so was population based prevention.  Dementia as a specialised service was also covered in another work stream.

 

d)         Key targets in the strategy were

·         Providing a crisis response in 4 hours and 24 hours as appropriate.

·         Providing support with 2 weeks of the 1^st episode of Psychosis.

·         IAPT target of 25% for support for some lower levels of anxiety and depression.

·         Liaison psychiatry – Core 24.

·         Perinatal Access.

·         Zero out of area admissions.

·         Reduction in suicides by 10%.

·         Parity of esteem.

 

e)         The strategic direction aimed to bring about a change in philosophy, attitude and practice to put greater focus on prevention and resilience in a more structured and robust way.  This would entail working with GP practices and health professionals on placed based area, whilst recognising that there would be different place based areas and different models of care within localities.  Community capacity needed to be captured and built into the models with clear end to end pathways to provide efficient and high efficacy clinical care.  The models would also be recovery focused.

 

f)          Achievements to date included:-

 

·         The Crisis house which provided an alternative offer for treatment without the patient going into hospital by providing a respite away from the home environment.  It was well used and very successful.

 

·         Improving the 4 hour urgent response to 71%.

 

·         The strengthened liaison service was now at 80%.

 

·         The all-age Mental Health Act place of safety had been rebuilt and was due to open on 5^th July 2017.

 

·         The new CAMHS crisis service would come into operation on 10th April 2017. 

 

g)            LPT were working with Northumberland, Tyne and Wear NHS Trust (rated as ‘Outstanding’ by the CQC) to rebuild the acute pathway to reduce the  current pressure on acute beds.  Northumberland had place based generic services and an open gateway to access services which had been successful in resolving problems at an early stage.  The length of stay in hospital for patients was far less than the national average.  If LPT could reduce the length of stay in hospital to those of Northumberland, this would increase the capacity of the hospital based service and  it would then be possible to eliminate the need for out of country placements.

 

h)           LPT were getting better at meeting patient’s needs, especially in instances where they don’t need to go into hospital.   The NHS 111 service was  linked to crisis lines and to the crisis house. 

 

i)             LPT hoped to have a female PICU facility in the near future.

 

j)              It was important to integrate the work on mental health with other work streams in the STP and to champion parity of esteem.  Mental health needs were equally important to other physical health needs and needed comparable investment.

 

Members made the following comments and observations:-

 

a)           It was difficult to understand the overall picture when the Dementia and CAMHS services were in different STP streams, as it was not easy to see how all the mental health services fitted together.  There was also no reference to mental health services provided to the Criminal Justice Service, and there were significant mental health issues affecting inmates in prisons and detention centres.

 

Response  – it was envisaged that STP process would help to strengthen mental health services and make them more resilient.  If the STP delivered the physical health care in the way that was envisaged it would eventually reduce the need for resources in emergency care and these resources could then be used elsewhere in the health system for services such as mental health.  Mental health services for the Criminal Justice system were commissioned by NHS England as specialised services.  LPT currently provided these services in prisons.   The issue of different mental health elements being in different work-streams was recognised but CAMHS was a critical part of the Children’s services work-stream.  The need to navigate the relationship between the different work-streams was part of the on-going work of the STP process.  Integrating with schools nurses, paediatricians, social care and health visitors would help to improve access and providing assessments for children.  These arrangements and pathways could be the subject of further report.

 

b)               Parity of esteem could be a missed opportunity if it was not included in the STP, as it was felt that there was a need to join life time issues together.

 

Response – The STP had been produced to a prescriptive format.  Producing it in a different format focused on what would be provided and the associated benefits to patients could have been helpful and more informative to the public.  For example 30-50% of patients with physical long term conditions also had anxiety, depression and other mental health issues and there was strong inter-relationship between physical care and mental health care services which could impact upon both the patient’s well being and the resources required from each service. 

 

LPT’s strategy for mental health had been informed and shaped by the views expressed in discussions with Healthwatch, patients, patients groups and community organisations over recent years in addition to the recent Mental Health summit held in the city.  Parts of the text in the STP were being revised, at the request of NHS England, and the comments made by Members were helpful to address the issue of describing the connections between the various work-streams and their aspirations.

 

c)            In response to a Members’ comment it was noted that the IAPT service was primarily aimed at people with low levels of mental health needs.  It was also available to those with long term chronic conditions in helping them to manage their conditions and reduce the patient’s need for increased physical health support.  Often patients with long term physical conditions also developed psychological stress.  The support given helped patients manage their conditions and live better with their conditions.

 

d)               Concerns were expressed that there were not enough trained people GPs and Police etc to identify intervention at early stage and there was a need to increase knowledge of mental issues within the community.

 

Response – There was an on-going need to reduce the stigma of mental health.  Episodes of psychosis were often self-evident but anxiety and depression were more common and people were less likely to talk about it.   10 years ago the only access to treatment would have been through the professional mental health service, but now there were other pathways, such as IAPT, which provided treatment earlier for lower levels of mental health conditions.  It was important to continue to identify and treat more moderate conditions earlier.  IAPT had originally been developed for patients with anxiety and depression but it now included people with long term physical conditions

 

The vast majority of patients with mental health conditions had low level needs and could be managed by GPs and social networks.  The number of patients with acute mental health issues were relatively small in number but represented a high cost for treatment and high risks to themselves.  The CCG were working with GPs to raise awareness of mental health issues and increase their ability to identify appropriate treatments.  There were improved links between GPs and consultants to help with advice on the next steps for a patient’s treatment between that offered by GPs and where an in-patient hospital treatment was not appropriate.   Often developing relationships, friendships and good social interaction was an effective means of improving good health. 

 

e)               It was felt that most people would prefer and appointment with a consultant for their next level of their care and not just a phone between a GP to a consultant to advise on their further care in instances where a hospital treatment was not appropriate.

 

Response – This type of model was being seen more and more in providing treatment for physical health conditions and it was important to use scare resources effectively given the current challenges faced by the health service.

 

f)                In response to a question about AHB117, it was stated that this referred to Alternative Health Placements for patients that required long term rehabilitation and specialised forms of treatment in other part of the country.  If other clinically safe treatments could be provided locally, the saving in financial resources could be used in improving other mental health services. 

 

g)               Doubts were expressed that it was realistic that mental health services would achieve parity of funding?

 

Response -  Whilst the ambition was to increase resources for mental health service both nationally and locally, this did present challenges in the current economic environment.  Part of the challenge in growing the budget for mental health services locally concerned spending less on the more specialised high settings of treatment and redistributing the resources in lower level services.  For example, sending patients out of county for in-patient treatment could cost approximately £500 per night; significantly more than if that treatment could be provided locally.  This required sufficient beds and qualified staff to be available and there were recruitment difficulties for nurses, psychiatrists and therapists.

 

h)              The BME community were under-represented in treatment for mental health conditions and often did not come forward for treatment through social stigma within their communities.

 

Response – The issues of social stigma within BME communities were understood and did present challenges, but it was important to ensure services were appropriate and responsive for this group.  Part of the working being undertaken with Northumberland and Tyne and Wear would result in building extra capacity within existing services that would be needed to cope with the rising demand for services in the future.

 

i)                Concerns were expressed that the proposed model of care could result in some people’s conditions getting worse before they were admitted to into a hospital setting.  If the mental team were not available for regular contact at earlier stages then people may present to the emergency department with more severe health conditions.

 

Response -  There was no intention of making people’s conditions worse by offering alternative treatments to keep them put of hospital for longer.  Patients would still be admitted at an early stage if that was the right and appropriate care for the patient. 

 

The Chair commented that it was difficult to reach firm conclusions without having the financial information for the 5 year strategy and how the mental health strategy related to other work-streams in the STP.  Whilst it was helpful to have discussions before consultation, there was further work to be done on the issues of connectivity, parity and budget implications.  Although the government were allocating more resources to the NHS, this was insufficient to cope with the increased demands being placed on the NHS by the growing population and people generally living longer with complex health conditions.  There were concerns that the STP process was budget driven to saving money. 

 

AGREED:

 

That the officers be thanked for their presentation and for responding to Members’ questions and the Commission would continue to consider and comment upon the proposals as the STP process progressed.