Midlands and East regional Mental Health Workshop February 2014 1
A review of the Midlands and East regionally led Mental Health and Dementia Workshop Held on 4 th February 2014 Report prepared by: Lucy Smith, Senior Development, Support & Intervention Manager, NHS England, Midlands & East 2
Contents 1. Summary 4 2. Introduction 4 3. Background to the event 4 4. Aims of the event 5 5. What we did 6 6. Who attended? 7 7. What we achieved 7 8. Actions and next steps 8 9. Appendices 10 3
1. Summary 1.1. In October 2013 Dr Martin McShane, Director for Domain 2 (Improving the quality of life for people with Long Term Conditions) wrote to regional Directors, regional Medical Directors, and regional Directors of Operations and Delivery asking them to hold workshops to support CCGs in delivering IAPT, Dementia and the Mental Capacity Act. In response, the Midlands and East held a workshop for Area Team and SCN leads in February 2014, with the event well received. A number of actions are planned as a result of the event, some of which were already planned, but which are now progressing with renewed focus and energy and greater understanding from key parties. Delivery will continue to be monitored via existing business as usual routes such as the Mental Health Focus and Delivery Group and assurance meetings. 2. Introduction 2.1 This report summarises the intended objectives and outcomes from the Regional Mental Health and Dementia Workshop held on 4 February 2014. 3. Background to the event 3.1 In October 2013 Dr Martin McShane, Director for Domain 2 (Improving the quality of life for people with Long Term Conditions) wrote to regional Medical Directors, Directors of Nursing and Directors of Operations and Delivery, outlining proposals for all regions to hold workshops to support Clinical Commissioning Groups (CCGs) with the following three priority areas: Improving Access to Psychological Therapies (IAPT) Dementia Mental Capacity Act duties 3.2 All of the above areas had been identified as high risk areas for delivery and are therefore high profile for NHS England. 3.3 In response NHS England Midlands and East convened a planning group, made up of the following individuals, to pull together a one day workshop: Lucy Smith, Senior Development, Support & Intervention Manager, NHS England, Midlands & East (event lead) Michelle Place, Domain Team Manager, NHS England Fiona McMillan-Shields, Deputy Director of Nursing Quality and Safety, NHS England, Hertfordshire & South Midlands Lucy McLaughlin, Operations & Delivery Manager, NHS England, Hertfordshire & South Midlands Martin Fahy, Network Manager, East Midlands Strategic Clinical Network Bernie County, Quality Improvement Programme Lead, Mental Health, Dementia and Neurological Conditions, West Midlands Strategic Clinical Network Mary Emurla, Network Manager, East of England Strategic Clinical Network 3.4 The aim of the planning group was to agree the objectives and themes for the event; plan and refine the agenda; identify key stakeholders (attendees/desired audience and speakers), and confirm a date based on availability of key individuals. Further planning sessions were also held nearer to the time with key speakers to clarify their role on the day, talk through agenda timings, and provide guidance as to session content. 4
3.5 The reasons why the event was being held and the objectives for the workshop were laid out in a letter dated 20 th December 2013 which was sent out, with a draft agenda, to Area Team Directors of Operations and Delivery; Directors of Nursing, and Medical Director, SCN Directors, and regional colleagues. The letter was supported by Dr David Levy, Regional Medical Director for NHS England Midlands and East. 4. Aims of the event 4.1 In response to the letter from Martin McShane NHS England Midlands and East held a workshop on 4th February for Strategic Clinical Networks (SCNs) and Area Team leads. Whilst it was made very clear that the event was about supporting and enabling commissioners to deliver improved mental health outcomes, a deliberate decision was made to give Area Team and SCN colleagues protected learning time to come together to better understand the mental health agenda, parity of esteem, and key changes to the NHS Mandate, without CCGs also being present. This was in response to strong feeling from all leads involved in the event planning process (and others engaged with separately outside of this) that there was significant variability of understanding of the issues, challenges and overall agenda plus different levels of engagement amongst these parties which needed to be addressed first. 4.2 The event was primarily aimed at nursing, medical, and operations and delivery colleagues from Area Teams as well as quality and programme leads, network managers, and directors from SCNs. In addition, members of the Midlands and East Operations and Delivery team attended to increase their understanding of the agenda, and members of the analytical service attended to help with data queries expected to arise during the event; as well as to further their own learning. Health Education England (HEE) representatives were also present given the link between workforce planning, leadership, and delivery. 4.3 The identified aims of the workshop were to: Engage Strategic Clinical Networks, Regional and Area Team Leads to work together to better understand existing work streams, progress, issues, challenges and areas of potential collaboration to inform ongoing CCG engagement in each Area Team and SCN footprint Secure regional and local focus and leadership for IAPT, Dementia and the Mental Capacity Act Better equip local teams to offer targeted support to those localities or commissioners who have significant distance to travel in the delivery of the above priority work streams Share and disseminate learning 4.4 The event therefore focused on clarifying the national priorities; delivery of the refreshed NHS Mandate; the importance of Parity of Esteem and what this really means; the economic and personal costs of mental ill health; and changes to the planning guidance and planning process for the development of operational plans and 5-year strategies for mental health and dementia. The event was designed as a practical session to better equip the above parties in productively engaging with local CCGs around the development of commissioning priorities, and to practically equip those supporting commissioners with the skills and knowledge to better influence the development of and assurance of commissioning plans currently in development. 5
5. What we did 5.1 The regional workshop opened with a presentation on the national perspective on Parity of Esteem / mental health. This session focused on the relevant content of the refreshed NHS Mandate and NHS England s duty to deliver this, and outlined what this means in reality for key parties. The changes to planning guidance were identified and the connection between planning guidance and the NHS Mandate outlined. Participants were also asked about their understanding of what Parity of Esteem means, and this highlighted a significant amount of variation in understanding in the room. The case for ensuring parity of esteem between mental and physical health was made in terms of the costs to the NHS; wider economic case for change; and the individual/personal impact. 5.2 A regional overview, focusing on the variation in delivery and outcomes across the region particularly in Dementia and IAPT, was then presented. It was noted that this appeared to be new news to many colleagues in the room. The presentation then touched on current workforce levels and the importance of workforce planning in the context of delivery of services and improved outcomes. 5.3 Each SCN was then asked to present an overview of their current work programme and priorities and to outline their future work programmes or planning priorities. This session was in response to comments during the planning process that SCNs did not always know what neighbouring networks were working on; and in some instances this can create an issue for Area Teams who span multiple network boundaries. 5.4 After lunch the workshop looked at the tools and support offers available to Area Teams, SCN s and commissioners with an overview of the Intensive Support Team offer in respect of IAPT; an overview of the Mental Capacity Act (MCA) and some practical supporting tools and aides being developed by NHS England; a look at the Leadership Programme and the Dementia Calculator. 5.5 Delegates then attended one of four table top discussions, focusing on IAPT, Dementia, MCA, or leadership. These sessions were left quite open to allow participants to freely ask questions of their colleagues and national leads facilitating the sessions, and to explore areas of interest previously identified during the day. At the end of this session each table was asked to give some short feedback focusing on actions identified as a result of the workshop. 5.6 The event concluded with a presentation on the clinical perspective followed by a summing up of the key themes from the day. 5.7 Presentations on the day were given by: Joanna Powell, Domain Team Lead (Parity of Esteem), NHS England Dr Alistair Lipp, Deputy Regional Medical Director, NHS England, Midlands and East Els Drewek, Intensive Support Manager for IAPT, NHS IMAS Dr Geraldine Strathdee, National Clinical Director for Mental Health, NHS England Kate Schneider, Assistant to the National Clinical Director for Mental Health, NHS England Jane Appleby, Patient Experience and Safeguarding Manager, NHS England, Midlands and East and Adrian Spanswick, Consultant Nurse/Designated Nurse for Safeguarding, Leicester City CCG 6
Martin Fahy, Network Manager, East Midlands Strategic Clinical Network Bernie County, Quality Improvement Programme Lead, Mental Health, Dementia and Neurological Conditions, West Midlands Strategic Clinical Network Mary Emurla, Network Manager, East of England Strategic Clinical Network The agenda for the event is attached at Annex A. 6. Who attended? 6.1 The event was well attended by 40 delegates from NHS England, the three SCN s in the region, and Health Education England. Each Area Team in the region sent at least one attendee, with some sending a number of representatives. Area Team attendance was split as below: Arden, Hereford & Worcestershire (nursing and medical directorates) Birmingham, Solihull and the Black Country (Mental Health Supplier Manager) East Anglia (operations and delivery directorate) Essex (operations and delivery directorate) Derbyshire & Nottinghamshire (Patient Experience Lead) Hertfordshire & South Midlands (operations and delivery and nursing directorates) Leicestershire & Lincolnshire (nursing and medical directorates) Shropshire & Staffordshire (nursing directorate) 7. What we achieved 7.1 Feedback was sought from attendees via dartboard feedback forms, as used by the South region to evaluate their mental health workshop held in January 2014. The reason for using the same form is to enable some comparison and analysis of results and feedback from regional workshops at national level, notwithstanding that direct comparison may be difficult due to the differences in how the events were structured. It was also felt that the forms were very useful and it was unnecessary to develop a different way of obtaining feedback. 7.2 Half of attendees completed a feedback form after the event. Responses were mostly very positive. Most people found the event a good use of their time which contributed to improved understanding of the priorities. A consolidated copy of the dartboard responses received is attached at Annex C and further analysis of the feedback received is at Annex D. There appeared to be a good amount of energy throughout the day, delegates appeared engaged with presentations and discussions and actively asked questions of colleagues and speakers, and there was enthusiastic discussion during table top sessions. 7.3 It is, however, worth noting that participants may have had little previous exposure to mental health learning opportunities, and thus may not have had similar experiences against which to benchmark. Those who attended the event may also have been more interested in working to address mental ill health and in improving outcomes. It is recognised that this may have positively influenced feedback, however these factors notwithstanding, the event was deemed a success based on the following: The event was attended by key representatives from all of the organisations expected to attend. 7
Each Area Team sent at least one person to the event, and in some instances Area Teams sent a number of people from multiple directorates. In terms of therefore reaching the intended audience the event could be called a success. The overwhelmingly positive feedback around all aspects of the event, including improved understanding of the national ambitions for improving mental health services; finding the event a good use of individual time; helping attendees to play an effective part in improving mental health outcomes; and finding the event well organised. Specific comments from delegates, including feedback on the benefits of the table top discussions; and comments from Area Team leads that they now feel better equipped to critique and assure CCG plans around mental health content; comments that attendees had noticed improved collaboration already beginning as a result of the event; and feedback that presentations were inspiring, for example. The event helped to kick-start conversations between Area Teams and SCNs as to how they might work together going forward, and comments from delegates were that both parties now had an increased understanding of each other s roles. Comments from attendees that it was useful to have someone speaking who also has a role with HEE as well as with NHS England, and feedback from delegates that they will now be looking more closely at workforce planning related to delivery of improved mental health outcomes. Subsequent feedback from national leads who commented that the event was powerful and delivered tangible outputs, with the region now better placed to improve outcomes as a result. Feedback on actions already underway or in the process of being taken forward as a result of the event (this is covered in more detail in the following section). 8. Actions and next steps 8.1 The workshop provided an opportunity to hear from national speakers and SCNs to galvanise regional and area teams to consider how they may start to address this agenda. Actions identified through the feedback forms confirm an appetite for: Taking away examples of best practice and sharing these with peers and immediate colleagues Further exploring of best practice models and opportunities Further networking and collaborative working A desire to learn more from colleagues and key speakers 8.2 There is a need to give further consideration as to how to keep the momentum from the event going over the coming weeks and months and to ensure that the ambitions for improving outcomes for mental health and dementia are embedded within the planning round process and the development of 2-year operational plans and 5-year strategies, and through these processes realising the ambitions set out in Parity of Esteem. 8.3 Some actions identified, and in some cases already progressed, from the workshop include: IAPT The Essex Area Team reported back about their renewed enthusiasm and energy following the event, and on their plans to focus on the delivery of improved mental health outcomes. This includes plans to hold a local workshop with commissioners and providers, linking with the IST Team, SCN and National IAPT Programme, and plans to also have regular meetings with commissioners focusing on delivery of IAPT. 8
The Midlands and East region are working with the national support team to set up a commissioner only event on IAPT, particularly linking with the leadership agenda, for commissioners across the Midlands and East region. A proposal to do this has been circulated for discussion with Area Team colleagues on 18 February. Webinars In common with the South, workshop participants supported the idea of follow up webinars. Regional and national colleagues are now quickly establishing a series of webinars for Area Team colleagues on a variety of topics, including Parity of Esteem, and IAPT which are relevant to the planning process. It is anticipated that these will be publicised via a number of routes including the Area Team bulletin, and via Area Team and regional leads to raise via regular meetings and forums. It is also planned that these will be filmed and made available via the internet for interested parties. Longer term plans for webinars on a variety of other topics, including the crisis concordat and suicide prevention, are being examined. Dementia Aligning a number of bullet points, captured from the day, to some of the existing indicators / outcomes, to aid assurance of CCG plans. A further suggestion is to record and capture the dementia webinar being run on 17 February as a follow up to the South workshop, and to share this with a wider audience. It is however not yet clear to what extent this may focus on shared themes or whether it will only cover local issues. Data and analytical support Analytics colleagues in the region have already made a start on adapting relevant data reports to support those responsible for the delivery of mental health services and outcomes. Whilst there was already a feeling that reports needed updating the workshop confirmed this. Plans include broadening the distribution list for data reports to include all people (e.g. SCN managers) with an interest in Mental Health Services can receive reports which monitor delivery of commitments. It was also identified that some people need help to identify key messages from reports. In response the team are reviewing and updating reports on progress against IAPT standards to make it easier to identify key messages. In response to feedback from event attendees that they found the background information on IAPT services provided by the national team helpful for understanding the reasons for variation in the delivery of key standards the analytics service has committed to developing some more in-depth reporting in addition to current performance summary reports. The team have outlined that they will be thinking through how they will get feedback on whether any changes made have improved things for data recipients. SCN colleagues involved in the development of local dashboards to monitor delivery have outlined their intention to work more closely with their counterparts undertaking similar work. Other One Area Team Director of Operations and Delivery has advised that they are now seeking to work more closely with neighbouring areas, and are already discussing the potential of a joint approach across the three areas in line with the local SCN footprint. HEE colleagues have articulated their intention to disseminate information from the workshop more widely and to feed this into their education and workforce plans. 9
Annex A - Event agenda AGENDA Mental Health Learning Workshop Tuesday 4th February 2014, 9.30am 3.15pm The Legend Suite, Leicester Tigers Rugby Club, Leicester Time Topic Speaker / Facilitator 09:30 Registration & coffee 10:00 Welcome and Introductions Housekeeping Joanna Powell, Domain Team Lead, Parity of Esteem Programme, NHS England Purpose of event 10:15 The National Perspective NHS Mandate Planning Guidance Parity of Esteem Issues & challenges 11:00 Midlands & East overview Overview of current position Issues & challenges 11:15 Break 11:30 SCN Overview Current work programme/priorities Future priorities/planning Issues & challenges 12:30 Lunch 13:15 Tools & support offers for Area Teams and CCGs IAPT Intensive Support offer Joanna Powell Dr Alistair Lipp, Deputy Regional Medical Director, NHS England (Midlands & East) Martin Fahy, SCN Manager, East Midlands SCN Bernie County, Quality Improvement Programme Lead, West Midlands SCN Mary Emurla, SCN Manager, and Caroline Dollery, SCN Clinical Director, East of England SCN Kevin Mullins, IAPT Programme Lead, NHS England, and Els Drewek, Intensive Support Manager Mental Capacity Act Dementia and the Dementia Calculator Leadership programme 14:00 Topic specific working sessions IAPT Mental Capacity Act Dementia diagnosis & support Jane Appleby, Patient Experience & Safeguarding Manager, NHS England (Midlands & East) Kate Schneider, Assistant to the National Clinical Director for Mental Health, NHS England Kate Schneider (please sign up on registration) Kevin Mullins and Els Drewek Jane Appleby Kate Schneider Leadership Dr Geraldine Strathdee OBE, National Clinical Director for Mental Health, NHS England 15:00 The Clinical Perspective Dr Geraldine Strathdee OBE 15:10 Conclusion Joanna Powell 15:15 Close 10
Annex B Event presentations All presentations can be found on the NHS Networks Regional Mental Health workshop website at: http://www.networks.nhs.uk/nhs-networks/regional-mental-health-workshop-mids-east To join the Network, you will need to: Register for a (free) NHS Networks account, if you do not already have one. To do this please go to http://www.networks.nhs.uk/@@register and open the registration page. Once you have registered, go to the Regional Mental Health workshop page. Annex C Consolidated dartboard feedback 11
Annex D Analysis of participant feedback 12