Agenda item

Members to receive a report and joint presentation from CCGs and LPT, explaining the proposals and associated background information in relation to the Step Up to Great Mental Health Consultation, as well as analysis of responses and highlighted themes.

Members of the Committee received a report and presentation providing details of the Step Up to Great Mental Health programme to improve and transform mental health services, which included the findings and analysis to the Step Up to Great Mental Health Consultation and an overview of the final proposals in the decision-making business case.

Andy Williams, Chief Executive Officer LLR Integrated Care introduced the report and gave a presentation with focus into the formal public consultation, figures around response levels, and the outcomes from the consultation including how the findings of the consultation were considered and the final proposals in the decision-making business case.

It was noted that the Step Up to Great Mental Health programme was jointly led by CCGs and Leicestershire Partnership NHS Trust (LPT) working with a broad range of partners and part of its purpose was to improve pathways to urgent and emergency mental health care and to strengthen the integration of community mental health services.

The Chair invited members to discuss the report and presentation. The ensuing discussion included the following comments and responses to Members questions.

Members welcomed the depth of consultation however there was some concern around the level of change being represented in the action plan and how that would be implemented. Assurance was given that there was a strong overarching commitment to rebalance mental and physical health and in broad terms resources were already in place. Funding this was not an issue and where necessary funds would be ringfenced. The action plan was about ensuring the programme was co-produced with partners and communities/voluntary sector organisations and that there was a mandate to act so CCG’s and LPT could work with stakeholders to achieve and deliver the best quality care in LLR.

Members were advised that some of the work around co-production was already happening, e.g., tenders were being issued and there was grant funding for more Crisis Cafes and improving learning in the local voluntary sector which was important too. There was continued engagement to bring services closer to local populations and all aspects were being done in partnership including with local authorities as delivery partners.

It was clarified that the term Crisis Café originally came about as the idea of a physical location where people could drop in when they felt unable to cope and needed some support. Crisis Cafes were linked with other services and helped to try to stabilise people and provided a local offer closer and more accessible to neighbourhoods with links to wider community assets too. At the moment Crisis Cafes were not including children as they would need a different environment, however LPT had tried out “Chill out Zones” this year which was a similar idea to a Crisis Café targeted to older children. In relation to plans to expand the number of “Crisis Cafes” grants were usually received in March and expected implementation could take up to 3 months thereafter. Marketing and publicising Crisis Cafes was still to be developed and would be wide ranging.

It was noted that the needs of people in rural/remote areas were very different to people in urban areas and Members expressed concern about how specific services would be in real neighbourhoods, as there was no definition of a neighbourhood in the report.

Members were informed that several discussions had taken place in rural parts and they were very different conversations, “neighbourhood” was not defined exactly in the report for the very reason that in the city it may be just a street whereas in rural areas it could be a whole village, and this was being explored further to establish what worked best in each area. It was noted that although the consultation was broad it revealed interest in other things too such as prevention, children services, older adult social care so there was a lot still to explore further. It was confirmed that the CCGs and LPT were every bit as focused on trying to meet the needs of people in rural areas as they were those in the city and towns.

In terms of partnership work and opportunity closer working with the police it was noted there were already close working arrangements in place, e.g., Leicestershire Police and LPT had been leading on street triage pilots and a Triage Car project since 2013, this brought together officers and health professionals in order to respond to people with mental health problems in public places and had reduced the number of people detained by the police and taken instead to a place of safety for mental health assessment.

Members referred to their experiences of Crisis Cafes noting feedback was positive and they provided comfortable surroundings for those attending. In terms of prevention, it was suggested that the Crisis Cafes could be used as an opportunity to work with community safety partnerships and other agencies in each area too, including Police and Fire services.

In relation to memory and dementia services it was suggested that rural areas often had an aging population and lower diagnosis rates for dementia. It was advised there were dedicated memory services across LLR, and the aim was to have seamless pathways as it was understood how important it was for individuals to get the right diagnosis. CCG’s/LPT were continuing to work towards that however there was insufficient research data around low diagnosis rates and one of the difficulties was identifying the issue which was often led by family/service users referring people for memory loss then coming into primary care where there was a bottle neck getting through the system.

In terms of the Crisis Cafes and Memory Cafes being facilitated by volunteer organisations there was concern that they were doing a lot of the work against a backdrop of reduced funding for the voluntary sector. Members were informed that the funding for Crisis and Memory cafes was joint, and their governance was intentionally integrated. The cafes were quite advanced in terms of their journey regarding mental health services as they linked to health and wellbeing priorities across LLR. Investment monies had been used for a range of things such as social care partnerships and dementia and this area of partnership working would continue to evolve over time.

In response to concerns around the involvement of volunteers in Crisis/Memory Cafes, their training and career progression opportunities and the issue of the lack of professional people in mental health services it was acknowledged that workforce in mental health services was a challenge nationally. In terms of voluntary sector workforce and retention that was still work in progress as different voluntary sectors may have different recruitment steps, but LPT would be looking to define roles and participants would be included in that strategy. Crisis Cafes were successful by operating with the voluntary community sector and part of this programme was sustaining those sectors too and giving them contracts and ability to channel success for their workforce whilst ensuring there was still access to professional and specialist skills when needed. It was noted that the Crisis Cafes were there to support but they were not in position to escalate access to professionals/services. The Chair indicated this was an area that needed careful monitoring to avoid deflection in future.

Responding further to concerns around funding, assurance was given that the financial resources were recurrent and there year on year with the intention that once those funds were committed, they remain so. The top steer was to ensure there was as much growth available for mental health services as for other acute services. This initiative builds on that and going forward that helps build a workforce too. It was noted that monies were linked to measures of success and outcomes would have to be demonstrable.

Concerns were raised that the consultation work on the programme was being done in isolation and queried how that would fit with GP and other services. In response health partners advised they were conscious they were consulting on a specific set of propositions, initially the thought was LPT would be main service provider however this was something that needed more consideration and health partners were willing to return to elaborate on how it would dovetail to other services at a future meeting.

Members were told that people conceptualise mental health and wellbeing differently and advised that the work being done in partnership was also focused on addressing and tackling areas of inequity. The proposals as they stand would contribute to greater equity of service. Some services had already been taken into direct access away from the route of GP’s to address difficulties accessing mental health services quickly.

There was some debate around whether the first point of call for someone in crisis would be to their GP and it was suggested that the extent to which people thought of their GP first varied substantially with some people remarkably well informed about other services available.  Members noted that there was no “wrong door” in terms of access to mental health services and there was a desire by CCG’s/LPT to ensure the right support was in place no matter the route taken. Health partners recognised the onus was not on the patient to navigate through services, that had been clearly heard from feedback during the consultation and LPT were keen to address.

There was a brief discussion around the potential for a mental health hotline that could signpost individuals to mental health services. It was noted LPT was trying to decongest GP services and give people simpler ways of access to mental health (and other) services especially when in crisis.

It was queried whether 6500 responses to the consultation were enough considering the population of Leicester, Leicestershire, and Rutland. In reply it was stated that although that number seemed small it was significant as it produced a wide ranging view and perspective, and it was important to note that every time a consultation was run there was a massive silent majority which was taken as them not having a particular view or concern on the proposals. 6500 responses were huge compared to other consultation response rates and online viewing figures of the proposals in addition to the actual responses showed large numbers had viewed the consultation material and the responses received were balanced demographically and geographically.

In relation to the wider issues of a person’s first encounter of mental health services being with the police and any learning points in relation to community safety it was advised there was a firm relationship with the police and other agencies, with established structures in place which included a process for case reviews. Assurance was given that there was a genuine determination to work on issues around community safety by all partners and Health partners were willing to examine their relationships with other agencies and service providers, and the process for case reviews to see if there was an issue and whether it could be improved.

The Chair indicated he would be interested in further discussion around Mental Health and police involvement at a future meeting. The Chair agreed to revisit the topic at the Autumn meeting of the committee and to receive progress on the implementation of the outcomes to the Step Up to Great Mental Health consultation

The Chair suggested it would be helpful outside this meeting to explore how key performance indicators (KPI’s) and dashboard monitoring would be taken forward.

AGREED:

1.    That the contents of the report be noted;

2.    That there be further discussion around Mental Health to include the involvement of the Leicestershire Police at the Autumn meeting;

3.    That this topic be revisited at the Autumn meeting and to receive progress on the implementation of the outcomes on the Step Up to Great Mental Health programme;

4.    That Health Partners in consultation with the Chair, Vice-Chair and Councillor Waller explore how key performance indicators (KPI’s) and dashboard monitoring shall be taken forward.