STRATEGIC TRANSFORMATION BOARD HEALTH and SOCIAL CARE Integrated Care Development Draft Minutes Thursday 28 February 2013, Room 11.4, 11 th floor Leon House Present Paula Swann (PS) Mark Justice (MJ) Stephen Warren (SW) - Chair Sharon Jones (SJ) Andrew McCoig (AC) Steve Davidson (SD) Jo Gough (JG) Hannah Miller (HM) Zoe Reid (ZR) Shade Alu (SA) In attendance Jacqui Lindridge (JL) Dev Malhotra (DM) Patrice Beveney (PV) John Haseler (JH) Bernadette Alves (BA) Brenda Scanlan (BS) David Norman (DN) Sue Balmer (SB) Shirley Ann Carville 1. Apologies for absence Apologies were received from Mike Robinson, Paul Greenhalgh, Tony Newman-Sanders, John Goulston, Dominic Conlin, Richard Brown and Folake Segun. Actions 2 2.1 Minutes of the last meeting The minutes of the meeting held on 31 January were approved with the following exceptions: Hannah Miller had sent her apologies. Jo Gough was present. Point 4.11 the last bullet should have read a more comprehensive handyman service. 3 3.1 4 4.1 4.2 Matters Arising The action log was reviewed. Update Overall Transformation Programme Shirley Ann Carvill presented an update on the Transformation Programme and advised that more work was required on the PID. Reference was made to the Transformation Strategy that had been 1
4.3 4.4 5 5.1 5.2 5.3 5.4 circulated prior to the meeting and members of the group were asked to feed comments back to Shirley Ann Carvill. Clarification was sought about the synergy of the workstreams with the Health and Wellbeing Board. Shirley Ann Carvill would share the background to the workstreams with the group. The observation was made that as part of transformation agenda it did not appear that anyone was responsible for publishing information to ensure people were aware of how services were being transformed and what they were expected to do as part of prevention and self management. The group was advised that this was very much part of the strategy but the work was not at a point where it could be actively shared. Mental Health Rationale/What progress was being made in Croydon Dev Malhotra talked about the rationale for the mental health integration agenda and the need to focus on the physical/mental interface. There was strong evidence that for many people with acute physical health needs, having access to appropriate mental health services was likely to impact positively on their physical health. This was beginning to be seen in the initial risk stratification work and had been highlighted in the mental health programme budget review and JSNA deep dives. A number of initiatives were being undertaken including; The IAPT pilot for people with COPD, and plans were being developed for an extended IAPT pilot for people with long term conditions The CUH CQUIN for improved alcohol services was aimed at a more productive link between physical health and substance misuse services The MHOA project was scoping a number of possible initiatives including ones that cross the primary/secondary and physical/mental interfaces The Clinical Leaders Group had recently decided that all projects would need to demonstrate that mental health had been given consideration Dev Malhotra talked about patients who turned up at GP practices with unexplained symptoms and that currently there was no easy access to support services to help them. He also referred to frequent attenders at A&E related to alcohol, substance misuse and personality disorder and how the transformation approach could help address this. With regard to the prevention and self management agenda consideration would be given to whether there was a bigger role for the third sector and what it would look like if liaison services were ramped up. There was a need to improve the quality of services, patient experience and outcomes. SC 2
5.5 5.6 6 6.1 6.2 6.3 6.4 6.5 It was noted that there was a stigma attached to people attending the IAPT service as it was linked to SLaM which was a barrier. There was a requirement to find a longer term view/solution and to look at whether there were better ways to utilise money to improve services. John Haseler said there was a high degree of integration between health and social care and progress was being made with regard to primary/secondary integration but there was more to do to provide a good safe service in a primary care setting. Future Directions What more can be done and how? Steve Davidson gave a presentation on the future direction of mental health, what more could be done and how. The presentation covered the following areas. Demographics: 23% of disease in the UK was due to mental disorder. Half of the life-time mental disorders arose by age 14 and there was a need for early intervention to prevent a larger proportion of physical illness which usually arose 2-3 decades later. There would be a substantial increase in black ethnic minority people from 14% in 2001 to 50% in 2022 which meant there would be an increase in people with vulnerability. Steve Davidson talked about the Rapid Assessment Interface and Discharge Service (RAID) which had been set up in Birmingham. This was a multi disciplinary liaison team that went onto wards to assess people. Steve Davidson would send information on the RAID model to the group. The A&E liaison team and Croydon liaison team for older people would be a good base to build on for a RAID team. The benefits of RAID were the capacity to react quickly when the need was identified and significant savings could be made in terms of reduced readmissions, saved bed days, and admission avoidance. There was a discussion about the Integrating Mental and Physical Healthcare: research, training and Services (IMPARTS) service which involved providing basic skills training to health care professionals and could be tailored to specific areas/needs. IMPARTs had been rolled out at Kings and Guys and St Thomas s and an interest had been shown in having this service in Croydon. It was noted that the service was currently only available in the acute setting but it was thought it could work in both acute and community settings in Croydon. The service was not expensive as it was based on training staff and realigning pathways. A benefit of IMPARTs was the informatics that had been developed to enable real time uploading of data into EPR so results were immediately available to clinicians. It was noted that in primary care between 20 and 40% of patients had medically unexplained persistent physical symptoms. The group was advised that a 3 year service development/research bid had been given to GSTT Trustee to pilot and evaluate new care pathways that would transect primary/secondary and mental/physical in Lambeth and SD 3
Southwark. Discussions were being held with the Maudsley trustees to explore whether funding could be made available to extend the work into Lewisham and Croydon. 6.6 6.7 6.8 6.9 6.10 6.11 6.12 The group was advised that the SLaM Mental Health of Older Adults Service was looking at the following areas: Croydon Memory Service referrals were growing and there was a need to build capacity to reduce waiting lists Capacity to support A&E and CUH acute pathways was being reviewed, there would be a refocus on hospital liaison (RAID model) and developing the Home Treatment model for older people Review/redesign capacity of CMHTs to support care homes Develop effective clinical pathways for the prescription of and review of anti-psychotics Review and update partnerships with social care Develop new partnerships with third sector organisations to promote new pathways. Jo Gough referred to the voluntary sector and said looking at separate hubs that were service specific might not be the best approach. The suggestion was made for some sort of brokerage arrangement at a local level to broker different levels of voluntary input and faith groups. It was recognised that stigma a big issue. Some people went to church and this should be considered when thinking about the pathways. Andrew McCoig referred to prescribing and the difficulty about providing diagnosis advice when it was not possible to determine the scale of the condition. The key to successfully managing mental health was compliance with medication and pharmacists did not have the right information to do that. Following the presentation there was a discussion about next steps and actions required to implement the good ideas that had been identified, particularly in terms of the initiatives at SLaM. It was important to have links into locality based MDT teams. Many of the population groups would have some element of mental health illness. There was a need for an on call crisis service and also to give teams the confidence to deal with mental health issues to prevent attendance at A&E. There was also a need to enhance the skills of district nurses. It was noted that a number of actions had been identified at the Mental Health summit. The group was advised that some of these initiatives were already in place at Hevers Court, which had good premises with a day centre, and other essential services. There was a need to achieve a jointly commissioned approach to the community mental health memory service and to get agreement on the provider side. A pilot team was looking at how to manage mental health in primary care. The suggestion was made to see if there was intelligence from other parts of the country that could be learnt from. The proposal was 4
made to use NHS investment to fund social workers in the six networks. 6.13 In terms of the physical/mental health position consideration would be given to how to pick up the actions and take the discussion forward. There was a need to understand the fit with the16 workstreams and to get the right people round table. The detail of this work would be picked up by the Implementation Group. 7 Any Other Business There was no other business. 8 Next Meeting 27 March 2013 1 3 p.m.children services, 5