MENTAL HEALTH AND WELL BEING SUPPORT GROUP. REPORT OF VISIT TO BORDERS 26 June Report of Visit to Borders 26 June 2001 (Pages 1 to 4)

Transcription

1 MENTAL HEALTH AND WELL BEING SUPPORT GROUP REPORT OF VISIT TO BORDERS 26 June 2001 Report of Visit to Borders 26 June 2001 (Pages 1 to 4) The 6 Month Progress Report - December 2001 (Pages 5 to 9) 1

2 MENTAL HEALTH AND WELL BEING SUPPORT GROUP REPORT OF VISIT TO BORDERS - 26 JUNE 2001 On this occasion the Support Group was represented by: Mrs Mary Fawdry, National Schizophrenia Fellowship Scotland Mr Brendan Gill, Director of Planning and Information, Lanarkshire Health Board Mrs Anne Hawkins, Chief Executive, Forth Valley Primary Care NHS Trust Mrs Elizabeth Hill OBE, Tayside Alcohol and Drugs Alliance Mr George Kappler, Inspector, Social Work Services Inspectorate Dr John Loudon (Chair), Psychiatric Adviser, Scottish Executive Health Department Mr Simon Porter, User Representative, Glasgow Association of Mental Health Mr Robert Samuel, Nursing Adviser, Scottish Executive Health Department In attendance: Mr Norman Harvey, Performance Management (East Boards), Scottish Executive Health Department Summary The Support Group recognised that in recent years a significant amount of effort has gone into re-providing local mental health service facilities. The delivery of services from new high quality in-patient units was achieved through the closure of Dingleton Hospital. That endeavour has skewed the development of community mental health services. Joint planning within the Borders should be relatively straight forward because of co-terminosity between Borders Health Board and the Scottish Borders Council. This has resulted in good working relationships at all levels within the local system. However the Planning and Commissioning structure is not working well and needs attention Findings The Support Group was particularly impressed by the following: The evidence of good working relationships both between the local health system and Scottish Borders Council and also between the Primary Care and Acute Trust. The meaningful input of users/carers to the Joint Commissioning Team. The renewal programme flowing from the Dingleton reprovision. The crisis response services provided by Penumbra. The community service for the elderly mentally ill. The high quality patient information system which is well advanced compared to many areas in Scotland. The well developed user led network - New Horizons. The Support Group had concerns about issues in the following areas and while not attaching individual timetables for action in each case, it will look to see early attention being given to these and recorded in the response to the request for a six months progress report. 1

3 Joint Commissioning Team It was evident to the Support Group that the Joint Commissioning Team was not functioning as a true commissioning team. There was a lack of clarity about the local planning system and the levels of accountability or responsibility. This was demonstrated through the lack of evidence for a prioritisation process, and some reported difficulty with communications. There seemed also to be a lack of feedback to sub-groups about proposals submitted which is unhelpful. Nevertheless it was recognised that the Joint Commissioning Team does meet regularly, that there is a need for it and that it does have a clear-cut function. There is now an opportunity to reinvigorate and develop the Joint Commissioning Team, perhaps with some external facilitation, and in doing so to review its membership, role, remit, and potential to delegate some of its functions. Strategy Implementation It was recognised that the Scottish Development Centre is currently undertaking a review of the results of the Dingleton Renewal Strategy; this will identify for the partner agencies in Borders exactly where the reprovided services are in their development and how effective they are. There is a need for the Joint Commissioning Team to ensure that each service area has a clear implementation plan for each year of the Strategy reflected in the Local Health Plan. Planning processes therefore need to be more robust around the redesign of services as well as potential for service development. Financial Resource There was a concern about the financial envelope for mental health services in the Borders reflected in the template completed before the visit. This indicated that community mental health investment had decreased in the last year which would indicate that it was moving in the wrong direction compared to the rest of Scotland. The Support Group would have liked to have seen evidence of funding plans for mental health over the next few years giving details for example of the way in which the receipts from the sale of the Dingleton site would be invested in healthcare in Borders, and what percentage would be invested in mental health. It was accepted that in the short term Dingleton receipts will be used in on a non-recurring basis to cover the overall financial deficit within the Borders. The way in which capital is subsequently to be reinvested over future years is of interest. It is recognised that in patient services for people with a learning disability require review and additional investment. Advocacy services, of various kinds, need to be enhanced or developed, as does provision for the support of carers. Some voluntary sector initiatives are funded on a year on year basis and will require ongoing financial support as does the user led network New Horizons. The Support Group therefore recommends that the Joint Commissioning Team work to produce a clear financial plan underpinning service plans for the next five years. Identification of Unmet Need During the course of the day the Support Group identified a range of services where there were gaps in comparison to the Framework. Examples include services for mentally disordered offenders, for psychological interventions with adults, for the older person with functional mental health problems, for children and adolescents and for liaison in the general hospital (particularly for the effects of substance and alcohol misuse). In any service system 2

4 there will be examples of unmet needs. It is recommended that the Joint Commissioning Team utilises the recent MH&WBSG publication on assessing mental health need to produce a robust needs assessment for mental health services. From this what is required can be jointly determined and thereafter services prioritised for development. Public mental health and reduction of stigma require attention as part of this process. The Support Group recognised that in an area such as Borders it may not be possible for some services to be provided and that there is a need for Borders to link with other Boards, to provide services on a managed clinical network basis. Engagement of LHCCs It is a challenge to all local mental health systems to ensure that primary care is signed up to local mental health strategies which often have been perceived as focussing on secondary rather than primary care. In this respect Borders faces the same challenge as many other areas. On the evidence available to the Support Group it seemed that the engagement of the two LHCCs in developing mental health services was very limited. There appeared to be some conflict between the role of the LHCCs and the role of the GP Sub Committee. It was suggested that this may be resolved as Borders moves towards its new NHS Board and new clinical advisory structure. The intention to develop a care pathway for depressive illness as part of the Borders New Routes to Care process may provide an arena for LHCCs to play a more meaningful part in the further implementation, review and development of the joint Mental Health Strategy. The Support Group looks for the issues identified and raised here to be addressed in the ongoing and future planned activity of all the agencies involved. As earlier indicated, the Support Group will request a written update on the progress made against the comments offered in this document in around 6 months. That update will be published on the web site alongside this report. Finally, the Support Group would like to thank all who attended and participated on the day and those whose contributions to the arrangements made the day and visit run smoothly. Mental Health and Well Being Support Group July

5 Appendix Background and Purpose of the Support Group The Support Group was formed on 31 March 2000 to support, influence and advance the further strategic development of mental health services in Scotland. The Support Group offers advice locally and to the Scottish Executive on solutions and best practice in advancing the implementation programme of the Framework for Mental Health Services in Scotland agenda for change and improvement in mental health services. The Group also provides additional focused local activity assessments to the Scottish Executive and the agencies involved. The Support Group complements, but does not replace related activity of the Joint Future Group, the mentor and advice remits of the Scottish Health Advisory Services, the Mental Welfare Commission or the Clinical Standards Board for Scotland. Approach/Process The Support Group issues a template, for completion by the partner agencies prior to visits. The template is based on Scottish Executive guidance material, and other relevant material including: A Framework for Mental Services in Scotland (1997) Advocacy A Guide to Good Practice (1997) Mental Health Promotion in Scotland Board Position paper HEBS (1998) Services for Women in Postnatal Depression NHS MEL(1999)27 Priorities and Planning Guidance for the NHS in Scotland (1998) Implementing the Care Programme Approach (SWSG/Accounts Commission Survey) (1998) A Shared Approach (Accounts Commission) (1999) Our National Health: a plan for action, a plan for change Risk Management (2000) Needs Assessment for a Comprehensive, Local Mental Health Service (2001) Annual Report Mental Health and Well Being Support Group (2001) During the visit individual members of the Support Group meet with groups of individuals, including users and carers, representing the range of stakeholder interests in the development and implementation of the joint mental health strategies in the area visited. Meetings also take place with the joint planning and implementation team and the key agency Executives. The Support Group is grateful for the co-operation and assistance of the statutory and nonstatutory agencies in the area. Further information about the Support Group, including its Annual Report, can be found on its web site at 4

6 MENTAL HEALTH AND WELL BEING SUPPORT GROUP PROGRESS REPORT - BORDERS VISIT REPORT PROGRESS REPORT AREAS FOR ATTENTION / ACTION ACTION INITIATED / REQUIRED LEAD GROUP / INDIVIDUAL TIMESCALE Joint Commissioning Team It was evident to the Support Group that the Joint Commissioning Team was not functioning as a true commissioning team. There was a lack of clarity about the local planning system and the levels of accountability or responsibility. This was demonstrated through the lack of evidence for a prioritisation process, and some reported difficulty with communications. There seemed also to be a lack of feedback to sub-groups about proposals submitted which is unhelpful. Nevertheless it was recognised that the Joint Commissioning Team does meet regularly, that there is a need for it and that it does have a clear-cut function. There is now an opportunity to reinvigorate and develop the Joint Commissioning Team, perhaps with some external facilitation, and in doing so to review its membership, role, remit, and potential to delegate some of its functions. Discussion of role and functioning of JCT at first meeting with new chair, Dr Lindsay Burley, in December Agreed to proposal for greater delegation consistent with a true commissioning role. Review of whole joint planning/commissioning process in Borders undertaken. Proposals for delegated commissioning & financial authority and responsibility from statutory bodies to joint commissioninmg structures to be discussed by NHS Board and Council in Jan/Feb and sent to SE. If these proposals are approved, as expected, the JCT will agree a new remit, review its membership and decide on its work priorities and mechanisms to address them over the next year or two. Dr Burley/ JCT. Ms Francis Stuart & Joint Executive. Dr Burley/ JCT. Completed. Jan-Feb Feb-May

7 VISIT REPORT PROGRESS REPORT AREAS FOR ATTENTION / ACTION ACTION INITIATED / REQUIRED LEAD GROUP / INDIVIDUAL TIMESCALE Strategy Implementation It was recognised that the Scottish Development Centre is currently undertaking a review of the results of the Dingleton Renewal Strategy; this will identify for the partner agencies in Borders exactly where the reprovided services are in their development and how effective they are. There is a need for the Joint Commissioning Team to ensure that each service area has a clear implementation plan for each year of the Strategy reflected in the Local Health Plan. Planning processes therefore need to be more robust around the redesign of services as well as potential for service development. The SDC report will be discussed by JCT as soon as it is available and actions required agreed. A stocktake of current sub-group work priorities was started at the December 2001 JCT meeting. The first draft Local Health Plan will be discussed at the next meeting in Feb Future priorities for planning/commissioning and implementation will be agreed and reflected in relevant plans. The un-met needs identified by the MH & WBS Group visit will be considered as part of these future priorities and will be candidates for re-design. JCT/Dr I Pullen Dr Burley/ JCT Feb-May 2002 Feb-May

8 VISIT REPORT PROGRESS REPORT AREAS FOR ATTENTION / ACTION ACTION INITIATED / REQUIRED LEAD GROUP / INDIVIDUAL TIMESCALE Financial Resource There was a concern about the financial envelope for mental health services in the Borders reflected in the template completed before the visit. This indicated that community mental health investment had decreased in the last year, which would indicate that it was moving in the wrong direction compared to the rest of Scotland. The Support Group would have liked to have seen evidence of funding plans for mental health over the next few years giving details for example of the way in which the receipts from the sale of the Dingleton site would be invested in healthcare in Borders, and what percentage would be invested in mental health. It was accepted that in the short term Dingleton receipts will be used in on a nonrecurring basis to cover the overall financial deficit within the Borders. The way in which capital is subsequently to be reinvested over future years is of interest. It is recognised that in patient services for people with a learning disability require review and additional investment. Advocacy services, of various kinds, need to be enhanced or developed, as does provision for the support of carers. Some voluntary sector initiatives are funded on a year on year basis and will require ongoing financial support as does the user led network New Horizons. The Support Group therefore recommends that the Joint Commissioning Team work to produce a clear financial plan underpinning service plans for the next five years. The spend on Mental Health Services has now substantially changed. The figures submitted previously did contain a "health warning as to their robustness. The BPCT have now had their accounts audited for 2000/01. The figures for Mental Health uprated to 2001/02 are as follows:- Hospital 8,356,700 Community Services 3,462,200 Resource Transfer 1,158,000 Total 12,976,900 Percentage of Total Resources 12.4% The above changes now reflect the spend in Borders on Mental Health Services. When this year s accounts are finalised and the ongoing costs of running the Dingleton site prior to its sale are completed then the exact costs in Borders of these services will be known (will reduce the figure for hospital services but not other categories). A review of advocacy services has just been completed and recommends a rationalisation of the existing services and a review of specialist services for people with mental health needs. This review will be undertaken through JCT. NHS Borders JCT On-going

9 VISIT REPORT PROGRESS REPORT AREAS FOR ATTENTION / ACTION ACTION INITIATED / REQUIRED LEAD GROUP / INDIVIDUAL TIMESCALE Identification of Unmet Need During the course of the day the Support Group identified a range of services where there were gaps in comparison to the Framework. Examples include services for mentally disordered offenders, for psychological interventions with adults, for the older person with functional mental health problems, for children and adolescents and for liaison in the general hospital (particularly for the effects of substance and alcohol misuse). In any service system there will be examples of unmet needs. It is recommended that the Joint Commissioning Team utilises the recent MH&WBSG publication on assessing mental health need to produce a robust needs assessment for mental health services. From this what is required can be jointly determined and thereafter services prioritised for development. Public mental health and reduction of stigma require attention as part of this process. The Support Group recognised that in an area such as Borders it may not be possible for some services to be provided and that there is a need for Borders to link with other Boards, to provide services on a managed clinical network basis. The JCT review of future priorities for action mentioned above (Strategy Implementation section) will consider the areas highlighted by the Visiting Group. It is acknowledged that the balance between different parts of the local MH service are not optimal. Some of the areas highlighted were already recognised as significant gaps, e.g. liaison psychiatry and psychological interventions; others are currently being discussed, e.g mentally disordered offenders; and one, mental health promotion/stigma reduction, has been addressed by a sub-group (although still needing further attention). The managed clinical network model will be considered and is very suitable for some of the areas mentioned above. Needs assessments targeted on the agreed work priorities will be undertaken to inform the commissioning process and the MH & WBSG report used. JCT Feb-May 2002 for work priorities. May for definitive work. 8

10 VISIT REPORT PROGRESS REPORT AREAS FOR ATTENTION / ACTION ACTION INITIATED / REQUIRED LEAD GROUP / INDIVIDUAL TIMESCALE Engagement of LHCCs It is a challenge to all local mental health systems to ensure that primary care is signed up to local mental health strategies which often have been perceived as focussing on secondary rather than primary care. In this respect Borders faces the same challenge as many other areas. On the evidence available to the Support Group it seemed that the engagement of the two LHCCs in developing mental health services was very limited. There appeared to be some conflict between the role of the LHCCs and the role of the GP Sub Committee. It was suggested that this may be resolved as Borders moves towards its new NHS Board and new clinical advisory structure. The intention to develop a care pathway for depressive illness as part of the Borders New Routes to Care process may provide an arena for LHCCs to play a more meaningful part in the further implementation, review and development of the joint Mental Health Strategy. Given the large number of issues facing these new organisations it is a challenge to secure their involvement. However, attempts are being made to do this. It is clear that the GP Sub-committee is an advisory body whereas the LHCCs are a key part of the local management structure and one which is increasingly having a strong influence on local developments. The LHCCs are involved in the work on the care pathway for depression. A proposal from the Mental Health Promotion sub-group is to be discussed with them shortly and it will be important to engage them in the work around psychological interventions. JCT/LHCCs MH Promotion sub-group May 2002 onwards. Feb