Purpose of the report: The Select Committee will review and scrutinise the ongoing Adult Social Care (ASC) Mental Health Transformation Programme, making recommendations accordingly.
Olive Aherne, Area Director, Richmond Fellowship
Karl Atreides, Chair, Independent Mental Health Network
Janice Clark, Governor, Surrey and Borders Partnership
Kirsty Gannon-Holmes, Senior Commissioning Manager (Mental Health)
Nick Markwick, Co-Chair, Surrey Coalition of Disabled People
Sinead Mooney, Cabinet Member for Adults and Health
Kate Scribbins, Chief Executive, Healthwatch Surrey
Liz Uliasz, Assistant Director (Mental Health) and Deputy Director of Adult Social Care
Simon White, Executive Director of Adult Social Care
Key points raised during the discussion:
1. The Cabinet Member for Adults and Health introduced the report, reminding the Select Committee that this was an update paper on mental health services now they had moved back into Surrey County Council Adult Social Care (ASC) following the decision to terminate the Section 75 agreement (of the National Health Services Act 2006). During the challenging journey to move these services into the Council, the focus had been on transition, training and supporting staff. Good progress had been made and the process continued.
2. The Assistant Director of Mental Health emphasised the use of strengths-based practice in the service and outlined the changes that had been made since the Section 75 agreement was terminated. Firstly, the structure of the team had been changed, as the team inherited had had no team managers. Two new teams had been developed: the mental health duty team, which acted as the service’s ‘front door’ during normal working hours; and the hospital discharge team. Work had also been done to ensure the service was linked into GPIMHS and Surrey Heartlands. There was more work to do around direct payments, creating robust structures and working with partners.
3. Regarding the service’s response to Covid-19, the Assistant Director continued to explain that since lockdown the team had been very busy – referrals and caseload had increased by 200 in the last six months and there had been an impact on mental health assessments both in and out of hours. There had been an increase in the number of Section 136 referrals, particularly amongst young people, and the service was working with the police on this. Overall, there had been an increase in the number and complexity of conditions. The service had been given guidance around virtual assessments in cases where there was a high Covid-19 risk, but, where appropriate, it had continued to conduct visits with PPE in the locality and check on people’s wellbeing.
4. A Member enquired what the timelines were for the service to achieve its goals, such as reinstating the Mental Health Programme Board Reference Group, working with the Surrey County Council Learning Disabilities and Autism (LD&A) team, and working together across area hubs. The Assistant Director of Mental Health replied that some of this work had been paused in the summer. However, in terms of the LD&A service, the ASC mental health team was working with Steve Hook, Assistant Director of Disabilities and lead for that service, and a report was being produced; joined up work between mental health and Autism Spectrum Disorder services in the Council was happening already. Regarding staff structure, the aim was to have the structure completed by June 2021. Moreover, a senior manager was in contact with the Independent Mental Health Network about setting up the reference group, which had been helpful to enable co-design, and it was aimed that this would also be set up by June 2021.
5. The Cabinet Member for Adults and Health suggested that the Select Committee could have representation on the reference group. The Chairman of the Select Committee agreed that this could provide more clarity for Members.
6. A Member noted that, while the Mental Health Task Group had highlighted record sharing as a point of weakness, in this report it stated that ‘there are no plans to extend access [to the Surrey Care Record shared data system] to the third sector at this time’ and that ‘it is likely that the patient will be able to share their own data with others on an individual basis’. Patients and other stakeholders were often not aware that patients could access and share their own data, while third sector organisations’ difficulty in accessing patients’ data complicated treatment. The Assistant Director of Mental Health stated that in the ASC service officers would always ask patients’ consent to share data. The section of the report on this was more about the development of a portal to facilitate data sharing. While the Surrey Care Record did not include every patient’s information, the ASC service would continue to lobby for this. The Member responded that it was important that health and social care professionals understood that patients already had the right to ask for and share their own data. Also, the work of the third sector was hindered if data was not shared with them too. This did not make sense when a number of third sector organisations were commissioned by Surrey County Council. She requested that officers report back on the issue of data sharing.
7. A Member referred to the £1.8m underspend forecast for the staffing budget and asked what the reason for this and effect on patient outcomes was. The Assistant Director of Mental Health said that this was an historic underspend caused by the struggle to recruit Approved Mental Health Professionals (AMHPs). The service did have locum staff but it was difficult in general to attract staff to mental health services. The LD&A service had done a good piece of work on recruitment and the mental health service was trying to replicate that with a targeted mental health recruitment campaign.
8. A Member asked for more information on care packages. The Assistant Director responded that there had been an increase in demand for care packages and the Council was working with Surrey and Borders Partnership (SABP) and commissioners to ensure pathways were right and people did not end up in bedded care unless necessary. The Council aimed to discharge patients into their own homes whenever possible with the right package of care. While care packages were a pressure on the budget, it was not felt that this was currently impacting on patients.
9. A Member requested an explanation of the performance figures in the report. The Assistant Director of Mental Health explained that certain performance targets should be kept low as it was important that services and assessments were only given to people who really needed them. Certain indicators (such as the percentage of people reviewed or reassessed in the last 12 months) had shown significant improvement since the end of the Section 75 agreement. The area that still needed work was direct payments: the current percentage of people in the community who purchased their service with a direct payment had decreased to 13.9%, against a target of 30%.
10. The Cabinet Member for Adults and Health suggested that officers include a glossary in future reports.
11. The Cabinet Member for Adults and Health also requested that Members assist the recruitment drive in mental health by sharing publicity on social media. A Member requested that witnesses share pre-prepared text and JPEG images with the Select Committee, for them to easily share on social media.
12. A Member proposed that mental health careers and apprenticeships be encouraged in schools and amongst people working in health (for example, GPs). The Assistant Director of Mental Health agreed to pass on this message to the workforce team.
13. The Executive Director of ASC emphasised that improvements had been made to the service following the termination of the Section 75 agreement.
14. A Member asked for more information on the service’s partnership with carer organisations based on its attendance at the SABP Carers’ Action Group and Carers’ Commissioning Group, and link with the GP lead for carers in Surrey Heartlands. How much influence did these groups have on the budget, for example? The Assistant Director of Mental Health replied that one of the managers within the service was the senior lead for carers. Partnership with these groups was less about budgets and more about having conversations that influenced staff practices. The Governor of SABP stated that these groups had been valuable for service users and carers.
15. With regards to involving carers in mental health in general, the Governor remarked that a whole family approach was important; it was important that ASC services put sufficient resources into adult services users whose carers were children, in order to alleviate pressures on the children and prevent mental health issues; and sound social care assessment processes were essential for the third sector to be able to do its work properly. Members agreed that it was important to intervene in and prevent mental health problems as early as possible.
Actions/further information to be provided:
1. The Assistant Director of Mental Health to share suitable pre-prepared text and JPEG images with the Select Committee for sharing on social media.