Agenda item

Witnesses:

Mark Nuti – Cabinet Member for Adults and Health

Liz Bruce – Joint Executive Director for Adult Social Care and Integrated Commissioning (Surrey County Council and Surrey Heartlands ICS)

Dr Helen Rostill – Deputy Chief Executive and Director of Therapies (Surrey and Borders Partnership)

Jonathan Perkins – Independent Chair of Mental Health System Delivery Board (Surrey)

Tim Beasley – Programme Director, Mental Health Improvement Programme (Surrey and Borders Partnership)

Toby Avery – Lead for the Mental Health Improvement Programme Digital and Data Workstream and Chief Digital & Information Officer (Surrey and Borders Partnership)

Liz Williams – Joint Strategic Commissioning Convener, Learning Disability and Autism and all age Mental Health

Kate Barker – Joint Strategic Commissioning Convener, Children and all age Mental Health

Clare Burgess – Chief Executive, Surrey Coalition of Disabled People

Patrick Wolter – Chief Executive, Mary Frances Trust

Key points raised during the discussion:

Cllr Frank Kelly left the meeting.

1. The Joint Executive Director (Heartlands and SCC) presented slides (Annex 4), emphasising that it was about phasing the existing plan, not making a new one. The Lead for the Mental Health Improvement Programme (MHIP) Digital and Data Workstream added that there were a number of strategic challenges regarding technology, and they were working to align technology with the service needs. The Independent Chair of the Mental Health System Delivery Board explained that there was a reset of governance in July 2022, whereby the priorities and scope of the work of the Board were set. There were now the right people on the Board to resolve issues of the plan and to move forward with clear accountability.

2. The Chairman noted that it was difficult to scrutinise the MHIP without the appropriate data or parameters of the priorities. The Joint Strategic Commissioning Convener for Learning Disability and Autism (LD&A) and all age Mental Health (SCC) explained that the Joint Strategic Needs Assessment was due to come to the Mental Health System Delivery Board in November 2022 which would provide data to support the priorities. The Joint Executive Director (Heartlands and SCC) shared that there were going to be whole system workshops looking at the financials across the system and what the operating model needed to be to stay within the financial envelope. There were also going to be quality and performance sessions to look at risks and quality, as well as understanding the pressures and finances to provide business as usual. The Joint Strategic Commissioning Convener for Children and all age Mental Health (SCC) added that there was work underway to identity activities and programmes which could have been badged as actions of the programme that could have greater benefits if done at scale and the outcomes recorded.

3. A Member asked about the system-wide cooperation that has occurred to help develop technology for mental health services. The Lead for the Mental Health Improvement Programme Digital and Data Workstream (SABP) shared that there was a disconnect between partners in relation to technology this time last year. Since then, there had been collaborative workshops to identify some of the gaps and to build relationships. A positive example had been the Technology Integrated Healthcare Management (TIHM) for the dementia programme. Inequalities remained for voluntary sector partners, as they struggled in terms of funding and capabilities to have the same level of digitisation.

4. In response to a question on the tech-to-community connect programme, the Chief Executive of Surrey Coalition of Disabled People explained that an area coordinator would spend time with an individual to help them get use to a device, and if they were ready to purchase their own device after the six months, the coordinator would support them to find a good deal. If they were not ready, they would be provided with another six month loan for a device. There was also a data support package whereby Vodafone provided six months of free data, and many were ready to purchase a Wi-Fi package after the initial period.

5. A Member asked about the lessons learnt from elsewhere with regards to technology. The Lead for the Mental Health Improvement Programme Digital and Data Workstream (SABP) explained that horizon scanning was done informally through professional connections and the wider network. Members of the team were regularly on calls with colleagues from across the country and experiences were shared. Surrey and Borders Partnership (SABP) were being broad with their recruitment opportunities to gain experience from other parts of the country and different sectors. The Deputy Chief Executive (SABP) added that they were testing a chatbot for Improving Access to Psychological Therapies (IAPT) services to support people to complete their self-referral.

6. The Chairman asked whether there was any evidence to indicate that the Section 12 app has helped to accelerate the speed of referrals to mental health services. The Lead for the Mental Health Improvement Programme Digital and Data Workstream (SABP) shared that the app was working well, but they were yet to do a formal evaluation. The Deputy Chief Executive (SABP) added that the app was used by all social workers involved in Section 12. The app did not automatically feed into the electronic patient records. The Joint Executive Director (Heartlands and SCC) shared that adult mental health professionals use the app, and it did feed into Adult Social Care (ASC) records. The Joint Executive Director would get a further update on the app.

7. A Member questioned what mitigations were in place to minimise any increased health inequalities due to digital exclusion. The Lead for the Mental Health Improvement Programme Digital and Data Workstream (SABP) explained that choice was critical and therefore, there would be in person and digital offerings of services. SABP had recently recruited a Digital Ethics and Privacy officer to consider digital inequalities and ethical implications of digital deployment. The Deputy Chief Executive (SABP) shared that the TIHM service was co-designed with those with lived experiences, their carers and families, industry partners, and health professionals. The health tech accelerator was bringing people into the heart of designing technological solutions. The Chief Executive of Surrey Coalition of Disabled People added that there was experimentation of preventative technology and mental health services within the third sector, such as, an off the shelf loneliness box.

8. A Member asked how the Fuller Stocktake had influenced the MHIP. The Joint Strategic Commissioning Convener for LD&A and all age Mental Health (SCC) shared that, together with ASC, they were looking at where the service was against the Fuller stocktake currently and would provide an update in future.

9. In response to a question on whether improvements in practice were the outcome of the efforts of the MHIP, the Joint Strategic Commissioning Convener for LD&A and all age Mental Health (SCC) shared that in the last four to six months the Integrated Care System and Integrated Care Board have recognised a visible improvement in the response and timeliness to complaints and out of area placements directed at SABP. They were looking at data across the system and more of the advanced analytics were coming together which would support such findings.

10. A Member asked how complaints and issues of concern regarding mental health services were being fed back into the Mental Health System Delivery Board. The Joint Executive Director (Heartlands and SCC) explained that there was an upcoming meeting looking at quality and performance, and risk and data in SABP. This would uncover how the service was improving delivery, what the risks and challenges were, and what the opportunities were. These meetings would occur monthly and feed into the Executive-to-Executive Assurance Board. The Joint Executive Director also had responsibility as the Senior Responsible Officer to provide oversight to the complaints around mental health services for adults and children and ensure the partners involved were responsive to the complaints.

11. A Member queried how frontline staff fed back issues raised on the ground and the Chairman asked about data collection regarding issues of concern. The Joint Executive Director (Heartlands and SCC) explained that the system needed to pick up formal lessons learnt. Themes raised were usually regarding being offered the wrong service, long waiting times, and not knowing which service to use. The Deputy Chief Executive added that the Co-production and Insight Group which fed into the Mental Health Service Delivery Board brought stories and experiences related to the MHIP.

12. A Member asked about the steps taken to overcome “bouncing” from one service to another. The Deputy Chief Executive (SABP) stated that it remained a challenge, but there were some positive steps. The One Team pilot in Epsom resulted in reduced waiting times and increased identification of ASC needs. The Adults Mental Health Alliance would allow for effective co-operation across the system. The Public Health team at the Council were leading on a review of the single point of access. The Programme Director (SABP) explained that bouncing was a key theme of the independent review and there were plans to introduce clear system leadership on this.

13. In response to a question on the use of safe havens as opposed to A&E, the Joint Strategic Commissioning Convener for Children and all age Mental Health (SCC) shared that there was a new member on the Mental Health System Delivery Board from the Office of the Police and Crime Commissioner, however, they still needed to consider how or if SECAmb would be represented. Ambulance services were, however, represented on the Co-Production and Insight Group. The Chief Executive of Mary Frances Trust explained that attendance at safe havens had still not returned to pre-pandemic rates. There was a mental health ambulance project group which was having discussions about blue light services referring individuals to safe havens and there was a review of the specification of safe havens. The Deputy Chief Executive added that they needed to build confidence in the paramedics with safe havens, when an individual did not need medical intervention.

Actions/requests for further information:

1. The Joint Strategic Commissioning Convener, Children and all age Mental Health to provide data on the uptake of the peri-natal mental health course.

2. The Joint Executive Director for Adult Social Care and Integrated Commissioning to provide a further update on the Section 12 app.

3.   The Joint Strategic Commissioning Convener for Learning Disability and Autism and all age Mental Health to provide a written update on how the Fuller Stocktake has influenced the Delivery of the Mental Health Improvement Plan.

Recommendations:

1. For the Mental Health Improvement Plan Digital and Data Workstream Lead to ensure to increase awareness of the Kooth system, and to ensure that it is increasingly enabling Children and Young People to access appropriate online support for their mental health; and to provide the Adults and Health Select Committee with a future written update on this.
2. For the Joint Executive Director for Adult Social Care & Integrated Commissioning and Surrey and Borders Partnership, to develop a robust process to deal with complaints as well as Issues of Concern regarding mental health services, and to provide a written update to the Adults and Health Select Committee on progress toward this.
3. For the Mental Health System Delivery Boardto use quantitative and qualitative data to direct the decision making process of the Mental Health Improvement Programme; and to update the Adults and Health Select Committee in a future formal meeting, on imminent/ensuing Mental Health System Delivery Board decisions on how to plan the delivery of the Mental Health Improvement Plan, and on what data was utilised to direct these decisions.