Annexe A: What the Like Minded Model means for people in Brent This document summarises the context in which the ambitions of the Like Minded Business Case have been developed, and will be implemented in Brent. The approach we have taken reflects the desire across North West London to deliver a common high quality response to needs, but that builds on different starting points and needs in each borough. The population in Brent has specific local needs Population: Brent has a GP registered population of 353,264 1, with 3.7% of residents reporting a long term mental health problem. The population is steadily growing, and this trend is expected to continue over the next decade. Brent has a very diverse population; 66.4% of residents are Black, Asian or other minority ethnicity (BAME) 2, and 37.2% of residents not speaking English as their main language 3. A minimum of six languages are needed to cover the main languages of only 80% of the borough s population. This presents cultural and linguistic barriers to mental health and wellbeing; not only does advice and care need to be available in a significant number of languages, but there is an added challenge that some languages do not have common-use vocabulary for describing mental illness. The effects of these challenges are late presentation and underreporting of mental illness, something which could account for the disproportionate use of mental health services by people of ethnic origin, registered by NHS Five Year Forward View Dashboard 4. Fig. 1: Contact with secondary mental health services by ethnicity 4 Housing and accommodation: there are significant challenges in the borough. There is a substantial shortage of general needs housing which has very long waiting lists for access. This leads to service users being delayed in moving on from supported accommodation, increasing lengths of stay in more intensive settings and increasing system costs. Furthermore, the shortage of placements often means that mental health service users are often housed in close proximity to individuals in drug & alcohol recovery as well as ex-offenders; the clustering of these groups has a number of negative outcomes, not least reducing the stability of mental health users. Instability in accommodation is a major cause of relapse among individuals 1 Brent CCG Annual Report 2015/16 2 Brent JSNA Overview Report 2015/16 3 Brent JSNA Overview Report 2015/16 4 Commissioning for Value - Mental health and dementia pack, NHS Brent CCG, January 2017, NHS RightCare, Public Health England 1
with serious and long term mental health needs, therefore improving accommodation for service users will have a direct positive influence on mental health and wellbeing. The incoming reforms to benefits are expected to place substantial increased pressure on housing, as well as health and social services across the borough. Latest data from the NHS Mental Health Dashboard 5 has Brent showing less people in contact with mental health services (per 100,000 population),and a similar number of admissions to inpatient care (per 100,000 registered population), to the London average. Fig. 2: People in contact with Mental Health Services (per 100,000 population) 6 Fig. 3: Admissions to inpatient care (per 100,000 population). 5 5 London Mental Health Dashboard, Summary Report for December 2016. Data sources: Fingertips (Public Health England) 2015/16 Quarter 2 and Mental Health Services Dataset (NHS Digital) 2015/16 6 London Mental Health Dashboard, Summary Report for December 2016. Data sources: Fingertips (Public Health England) 2015/16 Quarter 2 and Mental Health Services Dataset (NHS Digital) 2015/16 2
We have coproduced with Service Users, Carers, clinicians and other stakeholders Coproduction has been a theme throughout development of the model sometimes working across North West London, and sometimes at a borough level. In 2015 a series of workshops were run with service users (including members of the NW London mental health service user forum the Making A Difference Alliance), clinicians, and commissioners to understand the areas for development in current services and care pathways and to develop and pressure test this new model of care. These workshops focused on the needs and priority areas for change for people with serious and long term mental health needs. Data on current performance was used to inform the discussion and questions posed on how we could deliver more care out of hospital and better meet needs in the community. The workshops identified a number of key factors stopping us from delivering change, including workforce satisfaction, lack of integration between local authority, third sector and NHS, and a lack of flexibility in current systems. The workshops produced some key criteria to define what successful redesign of services and pathways would look like: Reduced need to access urgent care Improved self-management Care feels joined up with one point of contact in the community (physical, mental, housing, social, primary care pharmacy, voluntary sector) Increase value for money by better joining up of services and barriers coming down Continuity of care Flexibility in the system Ready access when needs of urgent care. Timely access. The feedback from these workshops has been used to coproduce the proposed model, working with services users, providers and commissioners to continue to refine and develop recommendations that have resulted in the model presented in this business case. Health and Social Care Working Groups (borough-specific) In Brent a dedicated cross agency group, the Brent Health and Social Care sub-group has been meeting to answer two questions: What are the implications of the Model of Care on social care? and; What solutions do we need to avoid admissions? The following objectives were set for this group: 1. Engagement and collaboration between all health / social care organisations and professionals involved in the pathways for SLTMHN; 2. Examining the Model of Care and determining whether it meets the service-user cohort s needs (with reference to individual service-user and service-user characteristics, circumstances and needs, plus treatment and support provided; 3. Determining and understanding service-user / activity flows in and out of acute secondary care services, and across other secondary care, community care and primary care 4. Provide a better, more sophisticated understanding of the service-user cohort and Model of Care; 5. Inform financial modelling and benefits realisation planning; and 3
6. Develop recommendations for community-based alternative support (to acute beds); an 'initial assessment' will help inform the development of the 'borough-specific' business cases to implement the Serious and Long Term Mental Health Model of Care Membership of the Brent Health and Social Care Group has included: Name Organisation Role Duncan Ambrose Brent CCG Mental Health Commissioner Helen Duncan-Turnbull Brent Council Head of Support Planning and Review Ian Buchan Brent Council Lead Commissioning Manager, Accommodation, Adult Social Care Jo Carroll CNWL Borough Director, Brent Anupam Kishore CNWL Borough Clinical Director, Brent Eric Craig CNWL Deputy Director, Brent Debbie O Mahony CNWL Business and Service Improvement Manager Colin Mowatt CNWL Senior Practitioner F H Making A Difference Alliance Service User Representative The SLTMHN workstream and business case are overseen by and have been presented to the Like Minded Transformation Board, whose membership represents all stakeholders: Organisation Name Role NW London Collaboration of CCGs Fiona Butler Jane Wheeler Chair NW London Mental Health & Wellbeing Transformation Board; Clinical Responsible Officer (CRO) for Mental Health & Wellbeing; GP Chair, West London CCG Deputy Director, Mental Health & Wellbeing ICHP Axel Heitmueller Managing Director of ICHP CNWL Claire Murdoch Chief Executive Grant MacDonald Director of Transformation Jo Emmanuel Divisional Medical Director WLMHT Sarah Rushton Director of Local Services Fin Larkin Divisional Medical Director Carolyn Regan Chief Executive Brent Sarah Basham CCG MH GP Lead Harrow Andrew Howe Director of Public Health Chris Spencer Corporate Director, Children and Families Paul Jenkins MD/COO Hillingdon Stephen Vaughan-Smith CCG MH GP Lead West London Glen Monks CCG MH Lead Central London Emma Coore CCG Clinical Lead Hounslow Annabel Crowe CCG MH GP Lead Ealing Tessa Sandall MD/COO Serena Foo CCG MH GP Lead Hammersmith & Susan Roostan Deputy MD 4
Fulham Beverley McDonald CCG MH GP Lead Tri-borough Liz Bruce Director of Adult Social Services CWHEE Clare Parker Chief Executive NHS England Hazel Fisher Assistant Director Programme of Care & NW London Locality Lead HEENWL Clare Etherington Head of Primary Care Education & Training West London Collaborative Jane McGrath Chief Executive Officer, West London Collaborative Healthwatch Raj Grewal Chair Hillingdon Healthwatch Making a Difference Alliance Please note this post is rotational Service User representation The Like Minded approach supports the CCG s Strategic Priorities The CCG s strategy has several stated strategic goals to deliver improvements in local people s health and wellbeing, which broadly align to the aims for the Model of Care: Support for people who have experienced mental health problems to live well in the community Promote recovery, resilience and deliver excellent health and social care outcomes including employment, housing and education Develop new high quality services in the community, focusing on community based support rather than inpatient care so that people can stay closer to home Services that provide urgent help and care which are available 24 hours a day 7 days a week for people who experience or are close to experiencing crisis. Support the North West London Sustainability and Transformation Plan (STP) We have made progress to date implementing the Model of Care in Brent In Brent, the following achievements have improved quality of care for people with serious and long term mental health needs: Urgent Care Transformation The new Single Point of Access was implemented in 2016, along with the Home Treatment and Rapid Response Team (HTRRT). Together these changes mean that urgent needs can be dealt with consistently and effectively in one place, enabling improved access to urgent assessment and care and improved ability to avoid unnecessary admissions Early Intervention in Psychosis and Specialist Pathways 5
The Early Intervention in Psychosis team delivers an evidence based specialist pathway to individuals who have experienced their first psychotic episode. The service is provided to individuals of all ages, and developed in line with NICE guidelines and new waiting time standards Community Services Redesign The Community Mental Health Teams in the borough provide a foundation of case management and multi-disciplinary care for individuals in secondary care. Community services have been redesigned to enable the continuing shift towards community-based care, and a move away from over-reliance on inpatient care. Peer Support Services We are currently in the process of rolling out the newly procured peer support service for Mental Health service users. The aim of this service is to create a model of health and social care support for adults with mental ill health across primary care and community settings. This will ensure service users access the interventions they need, and increase the support available to their support networks. Primary Care Mental Health Services Six Primary Care District Nurses (x5 Band 6 & x1 Band 7) are working with GP Practices. They are allocated across localities to support the provision of PCMH services for 'stable' patients (clusters 1-6 and 11) transferred to PC support through the Shifting Settings of Care Programme. What we will do next to implement the new Model of Care in Brent Setting of Care What already exists and is planned for implementation Discrete service directories for health, social and community care already exist, including the social care focused CarePlace commissioned by Brent Council. A Navigation service is being launched in 2016/17 which will provide support services to mental health service users, including service navigation, employment support and signposting. What will full implementation of the Like Minded Model look like Peer Supporters providing navigation services to mental health service users in the borough, with the aid of an integrated online service directory. This service will be assessed and evaluated in 2017/18. The Primary Care Mental Health Team will operate as a fully multidisciplinary team, case managing a caseload of service users in the community, supporting the GPs and ensuring individuals receive the whole systems support they need to stay well. GP support for holistic needs of 6
Setting of Care What already exists and is planned for implementation The fully operational Community Mental Health Team provides case management and specialist care in the community. The Early Intervention in Psychosis Team provides an evidence-based pathway of care for individuals who have experienced their first episode of psychosis. The new Single Point of Access was implemented in 2016, along with the Home Treatment and Rapid Response Team (HTRRT). This team gatekeeps 95% of admissions and is active 24/7. Brent service users occupy acute beds and a range of supported accommodation alternatives. General needs housing is extremely difficult to access in the borough. Acute inpatient bed usage in Brent is 25,915 OBDs (for 15/16) What will full implementation of the Like Minded Model look like individuals is bolstered in line with the Mental Health Five Year Forward View. Development of this team to respond to the increasingly complex needs of the caseload that this setting will need to support. Clinical standards are met through adherence to NICE guidelines and use of evidence-based therapies and treatments. Development of this team to respond to the urgent/crisis care needs of a growing population with increasing prevalence of serious and long term mental health needs Benchmarking shows Brent to be an outlier: we have indicated that the potential bed requirement would be 18,615 suggesting a reduction of 7,300 OBDs to achieve this. Alternatives to acute beds provide a safe environment outside of a mental health ward -e.g. supported living places or equivalent service. This will allow people to have care stepped up without being admitted to hospital, and will allow for easier and faster step downs to reduce lengths of stay in hospital. Additional discharge planning capability will be in place to enable flow. 7