Agenda item

Purpose of the item: To update the Select Committee on Surrey Heartlands’ Recovery Programme.

Witnesses:

Helen Coe, Recovery Director, Surrey Heartlands

Helen Rostill, Director of Mental Health Services, Surrey Heartlands

Giselle Rothwell, Associate Director of Communications and Engagement, Surrey Heartlands

Liz Uliasz, Assistant Director of Mental Health, Adult Social Care

Diane Woods, Deputy Director of Adult Mental Health Commissioning, Surrey Heartlands

Key points raised during the discussion:

1.    The Recovery Director stated that the Covid-19 recovery work had been ongoing since the first wave of the pandemic in March/April 2020. The recovery work included a major priority of restoration of services following the first wave and the report demonstrated that Surrey Heartlands was having considerable success prior to Christmas 2020 (when the second wave hit) in tackling the backlog that built up following the first wave and reopening elective care services. NHS England monitored the performance of Surrey Heartlands’ recovery programme against a trajectory. There had been mutual aid between providers throughout the recovery, and some positive changes had been made to the system, such as the introduction of virtual consultations.

2.    The Director of Mental Health Services said that the surge in mental health demand and acuteness had accelerated since Christmas 2020 and that the mental health impact of the current lockdown would likely be seen for some time to come. A weekly cross-sector group had been set up to look at mental health pressures and immediate actions that could be taken. Surrey Heartlands was looking at supporting people in their homes in order to improve their mental health; for example, by conducting deep cleans or providing furniture. There was also wraparound support for people with autism and mental health needs. Measures were being put in place to ensure people had support when being discharged from hospital. The Assistant Director of Mental Health explained that Surrey County Council Adult Social Care (ASC) had established a hospital discharge team to work with Surrey and Borders Partnership NHS Foundation Trust (SABP) and were looking to appoint an occupational therapist as part of this. There had been a significant number of young people experiencing mental health crises, and Surrey Heartlands was looking at providing additional resources to tackle this.

3.    The Assistant Director of Mental Health added that district and borough councils were working with SABP to provide longer-term housing for people with mental health needs.

4.    A Member asked how Surrey Heartlands was monitoring the capacity of the third sector to support the recovery. The Recovery Director replied that Surrey Heartlands had activated the ‘surge’ ability, which enabled them to take over six independent providers to use their resources and facilities. This was being monitored daily in partnership with NHS England.

5.    A Member enquired how capacity and demand were aligning in terms of autism support and how Surrey Heartlands was coping with specific areas of need. The Assistant Director of Mental Health stated that a social worker with a specialist autism and mental health background had been appointed in order to help people with autism and mental health needs to access resources.

6.    Expanding on the issue of eating disorders, the Director of Mental Health Services explained that a working group led by GPs and specialists had been set up, looking at monitoring the physical health of adults and children with eating disorders. The group had compiled a safety proposal interim plan involving specialist GPs to support the interpretation of diagnostics. This had now been approved by Surrey Heartlands and would be embedded into the service within the next two to three weeks.

7.    A Member asked whether people were choosing not to undergo elective procedures due to concern about catching or spreading Covid-19, or whether elective surgery was being cancelled by hospitals to increase capacity for Covid-19 patients. The Recovery Director responded that there was a combination of the two. All patients on the waiting list for elective procedures had been clinically validated, and patients had been given the opportunity to choose to be categorised under priority 5 or 6, meaning they would opt to delay their operation until later in the year, in order to try to avoid the coronavirus during the current wave of the pandemic. People were still being encouraged to access emergency care and procedures.

8.    The Chair of the Independent Mental Health Network (IMHN) expressed disappointment at the lack of a recovery plan for the mental health of NHS staff in the report, many of whom had undergone significant pressure during their work throughout the pandemic. What percentage of the workforce in the NHS in Surrey were unable to work because of mental health issues, such as stress or depression? What resources were available to support NHS staff? Also, if there were staff shortages due to absence, would there be enough capacity for Covid-19 patients in hospitals? The Director of Mental Health Services explained that it was difficult to obtain the exact figure of the number of staff experiencing mental health issues, but research showed a significant impact on the wellbeing of the NHS and ASC workforce nationally. In response to the second question, the Associate Director of Communications and Engagement said that a staff resilience hub had been set up for all staff across Surrey Heartlands, and this had been heavily promoted in recent weeks. The Director of Mental Health Services added that the resilience hub was free, confidential and part of a national network. Through the hub, staff could be fast-tracked to Improving Access to Psychological Therapies (IAPT) services and access drug and alcohol services, self-care resources and webinars. Surrey Heartlands was starting to collect data on users of the hub. Furthermore, in response to the impact of the pandemic on staff working on intensive care units (ICU), Surrey Heartlands was looking at another initiative to enhance support for ICU staff. The Director also emphasised the importance of practical steps, such as ensuring staff had sufficient breaks and time to decompress after their shifts.

9.    A Member asked whether annual health checks for people with learning disabilities (LD) had still been conducted throughout the pandemic. The Director of Mental Health Services confirmed that there had been a reduction in the number of health checks conducted for people with LD and for those with serious mental illness, in part due to the fact that some health checks needed to be conducted in person, and due to increased pressures on primary care. Work had been conducted on digitalising and increasing access to health checks. This was also a national issue; the target for the number of health checks for people with LD had been reduced nationally.

10.  A Member questioned whether Surrey Heartlands was working with an organisation like Sight for Surrey in order to increase digital inclusion. The Recovery Director stated that digital inequality had been recognised by Surrey Heartlands as a health inequality, and Surrey Heartlands had set up a Health Inequalities Board, which had a plan to tackle health inequalities.

11.  A Member noted that some residents were able to access digital devices through a small donation and would then only take on the cost of topping up the SIM card in the device. She remarked that regular SIM card top ups may not be affordable to someone on a tight budget.

12.  A Member requested data on the backlog, with regards to demographic and health condition. The Recovery Director agreed to provide this information.

13.  A Member asked how much longer restoration of services (including overcoming the backlog) would take for every week or month services were run on the basis of emergency treatment only. The Recovery Director replied that to recover from the first wave alone of the pandemic in terms of elective care would have taken about two years; this had since increased due to the second wave. However, the areas where there would be delays during the recovery process would be priority 3 and 4 procedures, whereby patients could wait for the procedure without risk of serious harm due to the delay. Surrey Heartlands had also put in place ‘green areas’ across Surrey where some elective care would be continued without this having a detrimental effect on acute care. Without knowing how long the pandemic would continue for, it was impossible to say how long it would take to recover, but Surrey Heartlands was starting planning now in preparation for when the pandemic did lessen in intensity.

14.  A Member asked whether there was enough support for people whose surgery had been delayed and who might be in constant pain. The Recovery Director said that in primary care and in acute hospitals, there were still specialist nurses who continued to provide pain relief services.

15.  A Member queried the effect of Covid-19 on the General Practice Integrated Mental Health Services (GPIMHS) programme and its continued roll-out. The Director of Mental Health Services stated that GPIMHS continued to be delivered, albeit in digital-only form for the time being due to the pandemic. While this had not slowed down the number of people using the service, Surrey Heartlands was making efforts to ensure GPIMHS returned to being face-to-face when possible. The service continued to work with Community Connections on GPIMHS and had recruited to all its vacancies. In terms of future ambitions, Surrey Heartlands was negotiating with NHS England for increased funding and aimed to ensure that GPIMHS covered all Primary Care Networks (PCNs) by 2023/24. The outcome of the negotiations would be known by March 2021. The Deputy Director of Adult Mental Health Commissioning added that out of the 25 PCNs across the Surrey Heartlands area, 11 were already covered by GPIMHS and, in line with NHS England guidance, the central funding facilitated rolling out GPIMHS to a further six PCNs in 2021/22, six in 2022/23 and two in 2023/24. However, Surrey Heartlands was looking at going beyond those further six PCNs in 2021/22 and delivering GPIMHS in all 25 PCNs earlier than 2023/24. The Director of Mental Health Services explained that there were also GPIMHS sites in the Frimley Health and Care area.

16.  The Chief Executive of Healthwatch Surrey requested assurance that residents were being engaged in the development of the recovery programme on an ongoing basis, particularly with regards to the full review of virtual appointments. The Recovery Director stated that a virtual consultation cell was conducting in-depth analysis, user research and feedback studies on this topic. Patients had been involved in the process and it was important to ensure that patients could use the channel of their choice; for instance, sometimes elderly patients would prefer not to use virtual channels. Overall, the feedback received on virtual consultations was positive.

17.  The Chief Executive of Healthwatch Surrey asked how the increase of out-of-county mental health placements was being communicated to families and carers of patients, particularly with regards to visiting patients. The Director of Mental Health Services acknowledged that out-of-county placements were less easy to coordinate compared to placements in Surrey and communication would be managed by the provider, rather than by the centralised service.

18.  A Member noted a reference in the report to changes in funding likely to put at risk Surrey Heartlands’ ability to use the independent sector to treat patients awaiting elective care. How were these changes likely to impact the recovery programme and Surrey Heartlands’ ability to purchase care? The Recovery Director explained that the changes to funding had in fact been put on hold due to the second wave of the pandemic, and that there were no issues with funding in the independent sector at present.

19.  A Member enquired how Surrey Heartlands calculated fees paid to a provider for care post-hospital discharge. The Recovery Director said that this information would be provided outside of the meeting.

20.  A Member expressed concern about the fact that home births had been temporarily suspended due to the pandemic and asked what additional support was being given to women affected by this. The suspension of home births could be a risk to the mental health of expectant or new mothers. The Recovery Director informed Members that the expectant mother would still have contact with the same midwife and group throughout her pregnancy. The decision to suspend home births had been taken by officers from the South East Coast Ambulance service (SECAmb) and Surrey Heartlands’ Chief Nurse, due to increased pressure on the ambulance service and an increase in average response time from seven minutes to 15 minutes. The suspension had been in place since 31 December 2020. It would be kept under review and home births reinstated as soon as it was safe to do so.

21.  A Member asked for examples of any positive changes to services that had come about because of the Covid-19 pandemic. The Recovery Director detailed that Surrey Heartlands was conducting imagery differently, such as providing imagery outside hospital sites, as well as having significantly expanded access to virtual consultations. Another positive outcome was the mutual aid that had been offered within the system.

22.  A Member asked what the Turning the Tide Board was, as mentioned in the report. The Associate Director of Communications and Engagement explained that this was a board addressing BAME (black, Asian and minority ethnic) workforce health inequalities. It was part of an initiative across the South East region. The Associate Director agreed to confirm whether the papers of the board could be passed on to the Select Committee, and to do so if possible.

23.  A Member asked whether the main barrier to mental health services for residents was funding, staffing capacity or a combination of both of these. Also, was mental health support mainly proactive or reactive? The Director of Mental Health Services replied that a focus on crisis mental health support meant that sometimes the service was not focused enough on early intervention. Nationally, mental health services were underfunded, and mental health funding in Surrey was slightly lower than the national average. As well as this issue, there was a shortage of qualified professionals, so recruitment could be challenging, but Surrey Heartlands had been successful in mental health recruitment despite this. The Deputy Director of Adult Mental Health Commissioning added that the expansion of the digital offer in mental health services due to the pandemic had increased access. However, there was still a gap in mental health funding. The Assistant Director of Mental Health emphasised the importance of working with partners in mental health, including Community Connections, district and borough councils and the ASC Learning Disabilities and Autism team.

Recommendations:

1. The Select Committee requests that a further update on the Covid-19 Recovery Programme is presented at a future Select Committee meeting;
2. The Select Committee requests that future recovery reports include information on mental health and wellbeing support being offered to NHS staff and social care workers;
3. The Select Committee requests that a report on the Digital Inclusion programme of work is presented at a future Select Committee meeting, and that this outlines what is being done to support those who are digitally excluded and unable to access services online.

Actions/further information to be provided:

1.    Recovery Director is to provide data on the specific demographics and conditions affected by, and part of, the backlog;

2. Recovery Director is to provide further information on how care sector fees relating to discharges are calculated;
3. Associate Director of Communications and Engagement is to confirm whether reports and findings relating to the Turning the Tide Board will be made publicly available and can be shared with the Select Committee.