Agenda item

Purpose of the item: To provide the Adults and Health Select Committee with an update on the implementation of the Community Mental Health Transformation Programme in Surrey.

Witnesses:

·         Professor Helen Rostill – Deputy Chief Executive, Surrey and Borders Partnership

·         Georgina Foulds – Associate Director for Primary and

Community Transformation, Surrey and Borders Partnership

·         Ane Sosan – Community Mental Health Transformation Programme Manager, Surrey and Borders Partnership

·         Patrik Wolter – CEO, Mary Frances Trust

·         Immy Marwick – Mental Health Lead, Independent Mental

Health Network

Key points raised during the discussion:

1.  The Deputy Chief Executive introduced the report and noted that the programme had a multi-agency approach. The programme was built through co-production with those who had lived experiences of mental health services. The witnesses shared four videos of personal stories with the Select Committee, which can be accessed using the following link: Adults and Health Select Committee - Thursday 3 March 202210.00am - Surrey County Council Webcasts (public-i.tv)(from 7 minutes 15 seconds). The Deputy Chief Executive explained that a lot of progress had been made, but there was still work to do. The Associate Director emphasised the complexity of the programme and noted that there were still a number of years until completion. It was highlighted that they would continue to listen to experiences of where they had not got it right yet and continue to reflect and learn. 

2.      A Member asked about how the programme was supporting young people transitioning into adult mental health services, as well as the accessibility of transition packs. The Member also asked about the link to health inequalities. The Deputy Chief Executive responded that the programme worked closely with Mindworks Surrey and the alliance programme to support those in transition. The Reaching Out service targeted all young people over 17 who were transitioning into adult services, which tried to bridge the journey for them. The transition packs were co-designed and developed with the Young Adults Reference Group, to try and improve the process around transition. The transition packs helped to guide conversation and listen to young people’s needs and ambitions. The Deputy Chief Executive explained that because the conversations were guided, it enabled staff to tailor the conversation appropriately. Recovery Colleges supported young people and their families through transition and were open to anyone who wished to attend. They offered a running programme of courses which had been codesigned. The Associate Director added that the Reaching Out service was to go live in the spring. In six to nine months, it would be appropriate to evaluate the work. The Deputy Chief Executive explained that work was also underway to develop a number of initiatives for young people with eating disorders to improve the service offer, including early intervention. 

3.      A Member raised the issue of a lack of continuity between services when transitioning, which often led to long waiting times and having to change counsellor. The Associate Director responded that the ambition was that the Reaching Out service would address these sorts of issues. The Deputy Chief Executive agreed that a challenge of transition can be moving from a trusted relationship with one professional to another. The Reaching Out service would offer consistency that was missing currently and enable the young person to settle into a new relationship. This was an area of continued focus and any feedback would be listened to. Evidence could be provided in the future, once the service had gone live.

4.      A Member asked about any lessons learnt from the initial rollout of the programme and how these had been incorporated into the second phase. The Associate Director explained that there had been significant learning as it was a new model and they needed to ensure it was meeting service user needs. The programme was set up during the pandemic and work was being completed to embed consistency of practice and adherence to the original vision of the model. It was crucial that the model was resilient. The Associate Director noted they had struggled returning to GP surgeries and accessing space due to the pandemic. There had been challenges around the information sharing arrangements in place and ensuring that the digital systems related to each other. There would be investment in existing teams whilst continuing to roll out the new programme. The Deputy Chief Executive highlighted the importance of working with partners. The CEO of Mary Francis Trust agreed that it was crucial for partners to work together. It was noted that information sharing continued to be a challenge; there was work underway to find solutions, but this was time consuming and would not happen immediately. The CEO emphasised the importance of locally embedded help which could direct people to the support available in a certain location. The model was combining medical and social approaches, and voluntary sector partners were crucial to this. 

5.      In response to a question on the structural limitations regarding transitions, the Deputy Chief Executive explained that there were plans to expand the age group considered under the transition service offer, but they were not there yet. A challenge was that practitioners would often feel that their training and skillset was either specialised for children and young people or adults. The workforce needed to be adapted to ensure that skillsets enabled practitioners to work across age groups whilst maintaining expertise. The Associate Director added that staff were being recruited from a range of backgrounds and that the new model would bring in a new skillset. 

6.      A Member queried what plans were in place to support recruitment and sought assurance that any secondment of staff would be sustainable. The Associate Director responded that their concerns a year ago were largely around recruitment and workforce challenges. This provided an opportunity to work differently with current establishments and think about the new skillset that was needed. It was important to think differently about what posts were needed and to move away from traditional roles, when bringing together new and current teams. The NHS had introduced a number of emerging new roles nationally and Surrey and Borders Partnership (SABP) could be embracing these roles more. This was a system facing programme where close working was required with all partners. The Associate Director explained that there was a desire to increase the workforce of people with lived experiences. When potential secondments would come up, there was great consideration of the impact of staff being moved and they would not be moved if it would result in destabilisation. The CEO of Mary Frances Trust reassured members that the approach towards workforce was changing, whereby there was a holistic approach rather than just clinical roles, and a greater focus on upskilling.

7.      The Mental Health Lead of the Independent Mental Health Network asked for clarity of the role of a mental health pharmacist, specifically in terms of medication management. The Associate Director explained that they would offer one session a week and would complement what was already available in Primary Care Networks (PCNs). They would provide specialist advice and consultation, as well as providing assistance to GPs about mental health care. There would also provide medication reviews. The Associate Director noted that they needed to have pathways and structures in place to handle that care safely and carefully. 

8.      A Member raised concern that the programme was short in staff for a number of roles and questioned how these staff would be recruited if they were already paying high salaries. The Associate Director explained that the table reflected the total establishment needed for the full rollout and the rollout was being phased. Therefore, it did not reflect the current recruitment challenges for the existing teams of the current rollout. The Associate Director explained that data could be provided to show the current teams in operation, the teams that were about to go live, and future need. The Community Mental Health Transformation (CMHT) Programme Manager confirmed that this was the case. There was a rolling recruitment programme aligned with when each team was planned to go live. The Deputy Chief Executive acknowledged that there were recruitment challenges in Surrey due to the proximity to London and the additional weighting in salaries offered there. There had been a long-standing problem with SABP, and the NHS more widely, to attract and retain staff.

9.      Responding to a question on the outcome of NHSEI (NHS

England and NHS Improvement) funding, the Deputy Chief Executive explained that they had not received the award letter yet, but they had received conditional approval and had been told to continue the rollout. The Member also asked about the working arrangements with colleagues from Adult Social Care (ASC). The Associate Director noted that ASC were a key partner within this programme and the governance structure. In terms of the workforce, there had been conversations about working together more and the reablement pilot was a good example of that. The aim was to have integrated models of working. The Member asked whether the partnership work was going well. The Deputy Chief Executive responded that partnership working was embraced, and the transformation programme provided an opportunity to improve and cement ways of working together. The CEO of Mary Frances Trust agreed that partnership working was developing, and the system had never worked closer. Although, there were challenges such as improving culture and relationships.

10.   A Member asked whether the GP Integrated Mental Health Service (GPimhs) was on target for rollout and how it was working with the Mental Health Improvement Plan. The Associate Director added that rollout plans were on track, and the financial mapping had support bringing the plans forward slightly, although they remained cautious because of recruitment. There were four new teams to go live in next couple of months (April/May 2022). There had been recruitment outside of Surrey and they were at a relatively good place considering the challenges. The Deputy Chief Executive explained that the programme was incorporated into the Mental Health Improvement Plan and addressed issues in the Plan. The Mental Health Partnership Board monitored progress and received reports from the programme. The Member asked whether they continued to work closely with Healthwatch Surrey and other third sector partners. The Associate Director assured the Member that they worked closely with those partners and listened to people’s experiences.

11.   In response to a question on the Pathway Forum, the Associate Director explained that there was weekly call with individuals who had been signed by GPimhs and could opt to step up or down, as well as colleagues from secondary care, ASC, community connections, ICAS providers, GPimhs colleagues. It was only taking place in Epsom at the moment but they were keen to roll it out further. 

12.   A Member asked what funding was still required and the confidence of acquiring it. The Deputy Chief Executive explained that they had 18 months of funding for the next stage of the enablement pilot and rehabilitation programme. The funding from NHS England was to come to an end at the end of the 2023 financial year, however, the funding would be included in the CCG baseline to enable continuation. The impact of the enablement pilot would need to be evidenced for it to continue. NHS England would keep the CMHT programme under tight scrutiny. 

13.   A Member asked about information sharing being a barrier for the third sector. The Associate Director explained that they were still working to untangle the legal complexities of using clinical record systems, it was no longer an issue due to unwillingness. The CEO of Mary Frances Trust agreed that it was moving forward and formal processes were being developed. 

14.   A Member queried the higher index of need for Surrey Heath and Guildford North and asked what work was being done to address it. The CMHT Programme Manager explained that it was an exercise to understand how to appropriately spread the GPimhs or MHICS teams across PCNs. This was based on a range of data including: GP registered population, mental health service activity, Single Point of Access Referrals, the percentage of patients with a new diagnosis of depression. There was the equivalent of two MHICS teams for the Surrey Heath PCN and one GPimhs team for Guildford North because it had a smaller population. 

Recommendations:

The Select Committee:

1.    Notes the significant work underway to fully implement the new integrated model of primary and community mental health across Surrey by 2023/24.

2.    Recognises the role of the Adult Community Mental Health Transformation Programme in delivering Priority 2 of the Surrey Health and Wellbeing Strategy.

3.    Requests the following reports at future meetings:

                                         i.    Individual Placement Support (IPS) – Employment support and collaboration with local businesses to support their own staff,

                                        ii.    Update on progress and impact of community mental health transformation in 12 months’ time.

Actions/request for further information:

1.    The Associate Director/CMHT Programme Manager to provide data on recruitment with reference to the current teams in operation, the teams about to go live, and future need.

2.    The Associate Director to provide more information on the Pathway Forum and the ambitions for the potential future rollout of the Pathway Forum.