Agenda item

Purpose of the item: To provide an update to the Adults and Health Select Committee on the implementation of the 19 improvement recommendations identified during the 2021 independent peer-led review of Surrey's mental health system.

Witnesses:

Sinead Mooney – Cabinet Member for Adults and Health

Joanna Killian – Chief Executive of Surrey County Council

Liz Bruce – Joint Executive Director for Adult Social Care and

Integrated Commissioning (Surrey County Council and Surrey Heartlands ICS)

Liz Uliasz – Deputy Director for Adult Social Care

Liz Williams – Joint Strategic Commissioning Convenor (LD&A)

Kate Barker – Joint Strategic Commissioning Convenor (CFLL)

Graham Wareham – Chief Executive of Surrey and Borders Partnership

Professor Helen Rostill – Deputy Chief Executive of Surrey and Borders Partnership and Director of Therapies

Sally Heath – Director of Business and Innovation (Surrey and Borders Partnership)

Patrick Wolter – CEO of Mary Frances Trust

Clare Burgess – CEO of Surrey Coalition of Disabled People

Key points raised during the discussion:

Frank Kelly left the meeting for this item.  

1.      The officers gave a presentation to the Members (Annex 1). The Deputy Director explained that the cost-of-living crisis and the war in Ukraine was impacting on residents’ mental health. Service users’ voices were the focus of the work and recommendations and a whole system response was required. 

2.      The Director of Business and Innovation shared that the General Practice integrated Mental Health Service (GPimhs) programme had been rolled out to 18 out of 25 sites, with planned for last 7 to go live by end of 2023. GPimhs is currently offering around 20,000 appointments per quarter As a result, there had been a reduction in routine referrals and bounce back. A one team pilot had been developed and early findings had shown reduced waiting times for psychologist services, improved working relationships, and early identification of social care needs. SABP had commissioned a piece of work to understand the resource and capacity across the system and a number of opportunities around resourcing and contracting mechanisms had been identified. 

3.      The CEO of Mary Frances Trust added that they had a system wide campaign to address the impact of the pandemic, led by a joint mental health communication group. It aimed to reduce the stigma and tackle health inequalities. By diverting five people it would offset the cost of the campaign.

4.      The Deputy Chief Executive of SABP emphasised the scale and complexity of the transformation programme. There was significant commitment from all senior stakeholders, but it had not translated into prioritisation, capacity and clarity of purpose. The governance had been fragmented and the right level of expertise was required to drive forward the programme. There was an agreement to share human resources, however, some partners were unable to provide the resource required to continue to deliver the programme. The impact of the pandemic was not declining for mental health and a vision had been lacking as well. The Chief Executive of SABP added that there was a lack of accountability which had now been addressed by the development of the Mental Health System Delivery Board which would govern the programme. 

5.      The Chairman questioned the clarity of decision-makers. The Chief Executive of SABP confirmed that there was clarity now.

The system had an integrated commissioning function and

the new Mental Health System Delivery Board included all the decision-makers. The Chairman additionally asked whether the shared vision and commitment from partners continued. The Chief Executive confirmed that all partners were committed to the vision. However, it was challenging times with pressure from the Treasury for the NHS to balance its books and the continued impact of the pandemic.  

6.      The Chairman asked whether key organisations were lobbying government for investment on the basis that it would produce savings in the long-term. The Chief Executive of SABP agreed that early intervention was required in the form of an integrated model within neighbourhoods. This would provide wider benefits for other institutions and society, however, these were hard to measure benefits. They had been talking to the national team at the NHS about investment. The Deputy Chief Executive added that for every £1 spent, it created a £3 return. System development funding had largely focused on higher end needs. There was a consultation on the ten-year Mental Health Plan that was ending in July 2022. The Chairman noted the funding formula which disadvantaged Surrey. The Joint Executive Director explained that all partners would be contributing to the call for evidence for the ten-year Plan to show that the formula needed to change to acknowledge the importance of early intervention. 

7.      A Member asked about the progress made to date in light of the impact of the pandemic on mental health services. The Chief Executive of SABP explained that they had significantly increased capacity in the most intensive services, such as purchasing an additional 30 independent sector beds. The surge and complexity of need was so great that they were not enough qualified practitioners. They were working to find new roles and to train staff but this would take time. The Deputy Director shared that there were individuals who had never previously had mental health issues, who were now needing to be detained. The Chief Executive of the Council added that the impact was coming through its contact centre as well. There was a specialist welfare support line who were facing challenging calls. The support offered to the Council workforce has been increased. School leaders welcomed wraparound teams which had been added to school communities. The Deputy Chief Executive of SABP shared that SABP had established a staff wellbeing hub called Here for You, open to staff of all system partners, which had 17,000 visits thus far.

8.      The Chairman raised cultural change, the Chief Executive of the Council explained that at the Council they spoke about good mental health for everyone, with a culture that valued being able to talk to each other so that individuals could spot when their colleagues were losing their good mental health. From a leadership perspective, mental health was a dimension of every conversation. There was more to do to tackle this issue earlier, especially for children and young people where the demand was high. The Deputy Chief Executive of SABP added that it started with early years and families. Honest conversations were needed to help to move forward. Comments from third sector colleagues in the task group report illustrated a commitment to come together in an alliance which demonstrated a shift.

9.      A Member asked about the work to raise awareness of mental health services. The CEO of Mary Frances Trust explained that there was a ‘time to change’ campaign funded by public health and delivered by third sector organisations to reach out to as many people as possible from a variety of backgrounds. The CEO of Surrey Coalition of Disabled People added that there was a programme called ‘tech to community connect’ which gave someone who was facing digital exclusion a device and matched with a tech angel who provided support. One of the target groups was those experiencing mental ill health. They were shown how to use their device to access therapies, social groups, or stay connected with another person. It was also important to continue to communicate in other ways than just digitally.

10.   The Chairman referenced the use of technology in service solutions. The Deputy Chief Executive of SABP explained that the pandemic accelerated the rate of digital technology which meant that a lot of services were being provided online.

Services were being brought back in person as the pandemic has reduced. A digital roadmap was being developed and embedded into Surrey Heartlands digital and data strategy plan. The Joint Commissioning Convenor (CFLL) added that the mental health digital road map was very active. It had been co-designed and had 20 recommendations; they were working on the costing of the solutions. The Deputy Director also added that through digital enabled care, more residents were staying in their home and being supported with technology.

11.   In response to a question on overcoming barriers for the black, Asian, and minority ethnic (BAME) and Gypsy, Roma, Traveller (GRT) communities, the CEO of Surrey Coalition of Disabled Peopled explained that the Independent Mental Health Network worked with Surrey Minority Ethnic Forum to conduct research into minority ethnic communities. This produced a summary report with recommendations to the system and progress had been good.

12.   The Chairman asked about the work with businesses in Surrey. The Chief Executive of the Council explained that they were adopting a workforce strategy across Surrey Heartlands and ASC around getting more people into the workforce that would not normally consider a career, such as, those with neurodevelopmental issues. The Joint Executive Director explained that they had made links with economic growth colleagues about developing a diverse and flexible workforce. The Joint Commissioning Convenor (LD&A) added that there were bidding to extend the individual placement scheme, which supported those enduring mental ill health. . Employment was a key part of the recovery journey and SABP were working with Chambers of Commerce to support workplace mental health. 

13.   A Member enquired about the inability of IT systems to speak to each other. The Chief Executive of SABP explained that that was a problem and Surrey Heartlands had engaged in an upgrade for technology and they would link into the Council. The Surrey Office of Data Analytics were looking to understand where the greatest need was. 

14.   A Member asked about Camerados public living room project. The CEO of Surrey Coalition of Disabled People explained that it was an international movement concerned with people’s wellbeing, with the message that people needed other people and purpose to live a happy life. The public living room concept which they would like to enable communities within surrey to establish in various locations. Funding would need to be secured first. 

15.   The Chairman queried how far the progress was from the original programme. The Chief Executive of SABP explained that they had prioritised a number of projects which did have funding attached. There was not enough capacity to deliver all of the projects concurrently. There was a financial recovery plan for the ICS and a new board had been established to bring together all of the projects. Other pieces of work had been identified but did not have clear timelines of when they could be achieved. The Chief Executive recognised that there was a gap. The Chairman questioned the speed and urgency of the delivery board. The Joint Executive Director explained that there was one system improvement plan and terms of reference and membership were roughly agreed. There was a set of shared actions and metrics and a shared commissioning strategy needed to be delivered. The Chief Executive added that the new plan included the same 19 recommendations sequenced through time. The Board’s role was to work out how to achieve that and there would be deliverables along the way. There was a significant funding challenge and there might be the need to lobby government. The Chairman queried the lack of key data that should underpin decisions, having requested this information over a number of years.  It was agreed that they would make this information available as a matter of urgency.

Recommendations:

The Adults and Health Select Committee recommends:

1.             For Surrey Heartlands CCG, Surrey and Borders Partnership NHS Foundation Trust, and Surrey County Council to continue to campaign for a change in the National Allocation Formula that would accurately reflect some of the mental health issues faced by Surrey Residents. 

2.    For Surrey Heartlands CCG, Surrey and Borders Partnership NHS Foundation Trust, and Mental Health leads in Surrey County Council to provide a future update and report to the Adults and Health Select Committee on the technology being sought, and the progress being made in rolling out technological systems to improve Mental Health Services in Surrey. 

3.    For Surrey Heartlands CCG, Surrey and Borders Partnership NHS Foundation Trust, and Mental Health leads in Surrey County Council to provide a future update and report to the Adults and Health Select Committee on how existing and additional funding will be effectively used to deliver on the Mental Health Improvement Programme, and to provide a timeline as to when the plan is expected to be delivered on.