Jocelyn Pike, Chief Operating Officer, NHS South Norfolk CCG Euan Williamson, Mental Health Commissioning Programme Manager

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1 Agenda item: 8.5 Subject: Presented by: Prepared by: Submitted to: Mental Health Crisis Hub Jocelyn Pike, Chief Operating Officer, NHS South Norfolk CCG Euan Williamson, Mental Health Commissioning Programme Manager Governing Body Date: 28 November 2017 Purpose of paper: To approve the concept of the mental health hub and to approve the proposals for moving forward with this. Executive Summary: Introduction No-one wants to have to stay in a hospital bed, whether it is for physical ill-health or mental ill-health. We believe that - just as we do with physical health - people should be helped earlier and closer to home, that they are empowered to resolve or stabilise their mental health issues before they escalate into a crisis and that they can remain safe and well at home. Therefore over the last twelve months, system partners and CCGs have been investigating the potential to create a community wellbeing hub for people with mental distress and mental ill-health. We would expect a hub to be a very important component in our primary/community mental health care model. It would serve to improve the mental and physical wellbeing of people drawn from the whole-population, not just for people with complex problems. It would provide a more appropriate option for people in crisis rather than there being the need for people to access statutory services, such as ambulance, police, and A&E. These services are often not always equipped to meet people s needs. Most importantly this approach can help prevent a crisis in the first place. There is also an expectation the hub could significantly reduce demand for mental health beds by empowering people to manage their conditions before they escalate. This would reduce pressure on secondary mental health services, and generate cost savings to enable investment in other health services. Experience elsewhere has also shown that out of county placements would be significantly reduced. It would also represent a very significant resource and support for GPs to draw on when patients present with mental distress or mental ill health.

2 The purpose of this paper is to ensure Governing Bodies are fully sighted on progress to date.. The Governing Body is asked to approve the outline proposal for the hub and the proposed approach to move forward with this work. A further paper will be brought to the Governing Body in the new year updating on progress and setting out detail on how the procurement will proceed with timescales as well as providing information to assist in selecting the appropriate estate for the hub. Outline proposal The outline proposal is to create a mental wellbeing hub. We would also expect health and care professionals to be able to refer patients/clients to the hub, managed via a triage telephone line. During the day the hub would include a cafe to support those who feel socially isolated and would aim to help de-stigmatise mental health for those people using this feature. The cafe should be open to the public. We envisage there being support for a range of mental health problems and for episodes of mental distress. It would provide a range of activities, advice, information and support. It would use a navigation and enabling approach, to empower people to stay well in their community and at home, and a peer-support approach rather than a strictly professional environment, employing people with lived experience, experts by experience working alongside support staff. During the evening the hub would offer a suitable and safe environment for people experiencing mental ill-health and mental distress. It would providing practical and emotional support, which could be used as an alternative to admission if appropriate. The evening hub would work closely with 111, police, ambulance and A&E to support people, where the hub would be a more appropriate venue. It should be noted the hub is not the default option for people who are homeless or presenting with other health or social needs in isolation of mental distress. Referral criteria will apply to ensure the hub stays within its clear remit and scope. Integrated approach A vital element of our model would be to co-locate professional support services from both the public and voluntary sector alongside the hub. Options might include the mental health telephone support line, the crisis resolution home team and adult social workers but we would not limit our ambition to just these examples at this early stage of this transformational way of working. The hub would serve the population of central Norfolk and would be based in Norwich. It would be aimed at people aged 18 years and over (as other age-appropriate facilities are already available to people aged under-18). People could be referred and/or signposted to the hub by health and social care professionals and other relevant agencies based on agreed acceptance criteria. As the diagram below shows, the hub would be an important element in our primary care model:

3 Potential system benefits The very clear benefits to patients are set out above and are the driver behind this proposal. In addition, we could expect benefits to the wider health system, including: A reduction in the number of presentations at NNUH A&E, by people experiencing a mental health crisis. The hub would provide an alternative support route for Primary Care and reduce the number of people requiring a consultation that includes a mental health element. Fewer emergency ambulance conveyances people experiencing a mental health crisis. A reduction in avoidable admissions to mental health inpatient beds and in referrals to the Crisis Resolution Home Treatment Team (CRHT). We have gathered evidence from similar hubs around England which have demonstrably improved care for patients and reduced pressure on beds and other statutory services: Leeds Survivor Led Crisis Service (LSLCS) - an independent study in 2012 concluded that a figure of 5.17 benefit per 1 invested should be considered the 'headline figure' as a cost saving. Bradford reports that in the first six months of the change taking place it saved 1.8 million, based on reducing all out of area placements to zero. They also report that this has been maintained for two and a half years, up to the present. In Lambeth, the CCG has reported a 43% reduction in referrals to the local mental health Trust and a 29% reduction in referrals to community mental health teams. Strategic fit The hub concept is consistent with local and national strategies: The 5 Year Forward View for Mental Health emphasises the need for community wellbeing and prevention services. It was recommended as part of the Mental Health Strategies review at Norfolk and Suffolk Foundation Trust (NSFT) which took place in May It promotes independence/greater self-management and out of hospital solutions in line with the Norfolk and Waveney STP NHS England has published information that indicates a hub model is essential to any mental health urgent response system.

4 Process Update Commissioners were successful in bidding for 150,000 of national capital funding that needs to be spent by 31 March 2018 otherwise it will no longer be available to the local system. With very tight deadlines to qualify for this extra funding we proceeded to explore a pilot model in great depth, with the intention of a full procurement open to all parties. This seemed a pragmatic approach, to ensure we provide local patients with this service as soon as possible. Extensive discussions with Norwich and Central Norfolk Mind took place, not least because Mind currently delivers the Wellbeing Service in partnership with NSFT and also provide the mental health support line. We identified a vacant property belonging to Norwich City Council which might be suitable as a venue, ensuring best use of public assets and integration of services. The option of running a pilot was taken to the STP Mental Health Forum; the concept was accepted by the Joint Strategic Commissioning Committee. However we have also listened to feedback from the STP Stakeholder Panel where there were concerns that a pilot before an open procurement/competitive tender might disadvantage other voluntary sector providers. Procurement was always going to be essential however the question posed was what was most pragmatic to deliver this solution for the people of Norfolk in a timely manner and also taking advantage of the available time limited funding. Procurement from the start is likely to delay provision of the proposed hub. However commissioners have concluded it is right they broaden their approach and explore all options in more depth, ask NHS Property Services to undertake a premises search and also run a four-week period of engagement across central Norfolk to discuss the plans for the hub and get further ideas from the public and professionals to understand how it can contribute to improving our population s mental health. This may jeopardise the chance of obtaining national funding because of the timing of the financial offer, however commissioners, having been able to explore a pilot model in depth, believe this is the right approach to take. Recommendation to Governing Body: To approve the outline proposal for the mental health crisis hub for central Norfolk; To note: the process to date; the plans to undertake an engagement exercise with the public, professionals and any other interested parties to obtain their views on the hub and to understand how it can contribute to improving our population s mental health; that a procurement will need to take place in order to find a provider for the hub services and that further detail on this will come back to the Governing Body early in the new year for approval. that an estates option appraisal will be brought back to the Governing Body in the new year in order to select the best possible estate to home the hub.

5 Key Risks Clinical: Finance and Performance: Impact Assessment (environmental and equalities): Reputation: Legal: The clinical risk associated with not implementing the hub could potentially be continued numbers of patients in out of area placements, continued pressure on crisis response services due to mental ill-health and high need for mental health beds. There is a significant risk that commissioners will not be able to access the 150k of capital money awarded as it needs to be spent by 31 March The initial assessment indicates the hub will not present a risk but will improve access for people experiencing mental distress from a range of communities. Evidence suggests that a hub model also improves health outcomes for those people who use it. A successful implementation of the hub will enhance the reputation of those organisations involved. However, there is a risk that some local organisations disagree with the approach and would prefer the funding is instead invested in additional mental health bed capacity. There is no current legal risk but a procurement process would create risks normally associated with conducting a procurement. Resource Required: Mental Health Commissioning Team, Procurement support, NSFT support and engagement from system partners Reference document(s): Five Year Forward View for Mental Health (2016) Mental Health Strategies Review (2017) NHS Constitution: Conflicts of Interest: N/A GOVERNANCE Process/Committee approval with date(s) (as appropriate) Governing Body 28 November 2017.