Agenda item

To receive an update on the Mental Health STP Workstream from Dr Peter Miller, Chief Executive, Leicestershire Partnership Trust and Jim Bosworth, Associate Director Commissioning & Contracting, East Leicestershire & Rutland Clinical Commissioning Group.

Dr Peter Miller, Chief Executive, Leicestershire Partnership Trust and Jim Bosworth, Associate Director Commissioning & Contracting, East Leicestershire & Rutland Clinical Commissioning Group presented an update on the Mental Health STP Work-stream.

The Chair referred to the briefing Members had received the previous week on the Five Year Forward View for Mental Health.  This had been useful to improve Members’ understanding of the issues involved and would be useful in considering mental health as part of the STP.

The Chair had attended the Healthier in Mind event in September which she felt had been a meaningful engagement event.  The Chair also noted that a further update report on CAMHS would be submitted to the Commission in November and that the CQC’s report following their planned re-inspection of LPT would be scheduled into the Commission’s work programme.

Dr Miller and Mr Bosworth in presenting the update stated:-

a)         Service integration underpinned all work-streams in the STP.  The focus in the Mental Health work-stream had been on recovery, prevention and that the care pathways could support people at earlier stages, manage crisis periods effectively and avoid hospital admissions.

b)         It was aimed to improve the access pathways to enable easier access to therapies especially for people with long term physical health issues that were also suffering from mild and moderate mental health disorders.  The target to assess people with a new presentation of psychosis was now 2 weeks and liaison had been improved to provide rapid access wellbeing and recovery hubs if required.  The need to send people out of county for treatment had been reduced from 30 people a year ago to the current level of 5.  The aim was to eliminate the need to send people out of county for treatment.

c)         The Trust were working closely with staff from Northumberland Tyne and Weir NHS Trust who have helped to design a new service process based upon their success of transforming the Trust from being in special measures approximately 5 years ago to a Trust currently rated as Outstanding by the CQC.  The service design process, called Healthier In Mind, had started by engaging patients to provide input into designing services that were attuned to what they wanted to meet their needs.  Having clear and easily understood pathways was also a prime consideration in the design process.

Members made the following comments and observations:-

a)         LPT were to be congratulated on signing up to the Armed Forces Covenant as many servicemen and ex-servicemen suffered from mental health issues

b)         There were references to VCS involvement in service delivery in the Plan and, as a number of VCS organisations had recently closed or had their funding reduced, had these been taken into account when preparing the Plan.

c)         The Plan should include more details of the pathways for engaging with services and contain more details of the services that would be available in the hubs.

In response to Members’ questions the following responses were received:-

a)         The CCG were working with the provider of crisis beds to get more capacity out of them. This work involved local authority staff and a housing association that had a strong track record of working with homeless which would give extra capacity to find appropriate accommodation.

b)         The plan addressed the issue of homeless people with severe mental health conditions where it would not be conducive for them to go into hospital.  All partners were discussing a broad spectrum of the needs of the homeless and were also developing new relationships with housing associations to improve service delivery.

c)         The 5 Year Forward View was considered to be a good starting point and it was recognised that there were wider issues to address.  The current report was prepared in response to questions raised by the Commission and the formal published document would include more detailed information.  The Plan was a national view and statements contained in it would be addressed in the local Plan, such as the proposals to eliminate the need for out of county treatment of patients.

d)         The Plan was continually being updated to take account of changing circumstances.  For example, the recent work undertaken in relation to the Healthier In Mind campaign would require various statements to be refreshed.  This would also apply to the VCS provision in the Plan.  The VCS were involved in launching new resilience recovery hubs with the intention of building a nucleus of what would develop to be an extensive network over time, which would not rely on the local authority to identify capacity in community, but allowed the capacity in the community to develop further.  Part of the process was to stimulate engagement in the process.

e)         There was a greater move to having integrated locality teams comprising GPs, nurses and other health professionals with a view to having fewer service points in a locality so people didn’t have to attend multiple locations for their care and treatment. 

f)          The Trust challenged a view expressed by a Member that treatment was not provided within 2 weeks for patients who were newly identified as having psychosis as the service readily accepted patients who had been tentatively diagnosed with psychosis by GPs.  These patients were then fully assessed and treatment started in appropriate cases.  The Trust were also reviewing the process to look at ways in which patients and families could query the pathway, or access to it, where the pathway was not working as intended.

g)         The CCG, as commissioners of services, had a number of sanctions that could be taken against poor providers of contracted services.  These increased in severity from discussions to address known issues arising from feedback on the services, through to financial penalties and then ultimately taking the contract away from the provider in extreme cases.  NHS England and NHS Improvement also provided additional monitoring and pressures to make improvements in poor services.

h)        Although the LLR bid to NHS England to extend the liaison services had not been successful, it was expected that there would be a further opportunity to bid for funds and the LLR intended to submit a another bid to fully deliver the Core 24 liaison services.

i)          It was acknowledged that the acute pathways were critically important in getting access to the appropriate services. These were not right at the moment, but work was continuing to put appropriate and effective pathways in place.

j)          50% of people accessing psychological therapies were from white populations in the city and 20-30% from BME populations, of which the majority were of an Asian ethnicity.  Data suggested that completion rates were similar for all people accessing the services but outcomes seemed to be poorer for BME patients.  Work had started on expanding access to the service for both BME communities and people who were also under-represented in accessing the service.

i)          The Trust had received the additional 2.5% funding for mental health services made available by the government, but it was still a challenge to provide services when the demand for mental health services could rise by 20%.  Service efficiencies were also being re-invested back into the system to meet the costs of the rising demand for services.

j)          The Trust were continually working in more collaborative and partnership arrangements through the Mental Health Partnership Board which included the Police and third sector representatives.  The Trust also had representations on other partnership boards such as the Braunstone Blues initiative; which also promoted a better co-ordinated approach.

k)         Partners across the LLR were re-launching the Suicide Prevention Strategy and Action Plan for 2017-2020 with the aim of reducing the number of suicides by 10% in the next 5 years.

l)          Crisis response was now working better than last year and people who were identified with early psychosis were being seen promptly.  There were still some issues for people who were referred to community teams experiencing delays in receiving support.

The Chair commented that the report had been written and presented to respond to specific questions which had been asked of the Trust.  Further discussions would continue with the Trust to refine ways in which information could be provided in future reports that provided information that met the needs and requirements of scrutiny.

The Chair also commented that there would be an opportunity to consider a report on an update for the CAMHS service at a joint meeting with Children, Young People and Schools’ Scrutiny Commission in November.  The outcome of the CQC follow up visit would also be considered at the Commission’s November meeting. 

It was acknowledged that there were clearly weaknesses with the 5 Year Forward View and there were many areas where the Trust were working to mitigate the risks associated with recruitment, staff training, parity of funding, increasing the understanding of mental health and dealing with increased demand and socio economic pressures.

AGREED:

(1)       That the Chief Executive, Leicestershire Partnership Trust and Associate Director Commissioning & Contracting, East Leicestershire & Rutland Clinical Commissioning Group be thanked for presenting the report and responding positively to Members’ questions.

(2)       Any further questions from Members relating to mental health provisions and the STP should be sent to the Chair and/or Scrutiny Support Manager which would then be forwarded onto the LPT and the CCG for a response, as happened previously with the Primary Care Forward View.

(3)       That a further report be submitted in 6 months’ time focussing on the work to address issues such as 24/7 services in acute hospitals, improved services for prevention and children having access to mental health services, improved access to perinatal mental health services and better access to physical health support.