Agenda item

In recent months the MHIP, and mental health improvement and transformation work more broadly, has undergone a reset, in order to address some of the challenges which have been found to date, to align with wider system ambitions and to build on our successes. This paper provides an update on the changes that have been made, and next steps.  It also asks the Health and Wellbeing Board to agree the Terms of Reference of the new Mental Health System Delivery Board. 

Witnesses:

Jonathan Perkins - Independent Chair, Surrey Mental Health System Delivery Board

Kate Barker - Joint Strategic Commissioning Convener - Children and Families, Surrey County Council and Surrey Heartlands ICS (Priority 2 Co-Sponsor)

Key points raised in the discussion:

1.    The Independent Chair (Surrey Mental Health System Delivery Board - MHSDB) noted that:

·         The Mental Health Improvement Plan is a piece of work that had been ongoing within Surrey for several years.

·         A peer report was produced in the early summer of 2021 which had multiple recommendations on the improvement of mental health, worked on by the Mental Health Partnership Board.

·         After a year a reset was needed to create more momentum to some of the recommendations from that peer report and from July that reset began and he was invited by the Board’s Chairman to chair the new Surrey MHSDB; in order to focus on those recommendations and review what was happening in the wider context in terms of mental health concerning: the development of the new ICS Strategy and inclusion of Surrey Heartlands ICS’s ‘Critical Five’, the implications of the Fuller Stocktake report and looking ahead to winter pressures as well as the cost of living crisis.

·         An update on that new governance in place, the summary of the new MHSDB and the draft Terms of Reference for the Board’s approval are included in Appendices 1 and 2.

·         Several senior people from across the system sat on the MHSDB to focus on how to deliver the improvements around mental health and emotional wellbeing in partnership.

·         The best of the previous governance arrangements formed the Co-production and Insight Group which had a broad membership from across the county who met together once a month; and the quality assurance of mental health was overseen by a new board.

·         There was a huge amount of work underway by the providers in the third sector and prioritisation was needed to concentrate resources. The MHSDB was undertaking a phasing exercise to look at what were the most important things that need to be achieved in the quickest time - Appendix 3.

·         The MHSDB was determined to move things forward as a partnership and unblock issues, making progress in the next few months.

2.    The Chairman noted that there had been two Mental Health Summits where there had been good discussion but what was needed was frontline delivery and the MHSDB was doing that.

3.    A Board member thanked the Independent Chair (Surrey MHSDB) for his leadership and time spent on revitalising the work, she also acknowledged the Joint Executive Director of Adult Social Care and Integrated Commissioning’s (SCC and Surrey Heartlands ICS) contribution to progressing delivery.

4.    A Board member was grateful to the Independent Chair (Surrey MHSDB) for the invitation to join the MHSDB, she noted that the draft terms of reference were comprehensive and she supported the work underway. She asked the Independent Chair (Surrey MHSDB) how he envisages the MHSDB would  measure the success of all the workstreams and priorities.

-        In response, the Independent Chair (Surrey MHSDB) recognised that the MHSDB needed to be able to show success and that was dependent on the different workstreams. He noted that the phasing work would focus on four different areas and within those there would be several priorities and workstreams. Within those, clear and precise delivery objectives would be needed and the MHSDB would not sign those off until it knows how, when and that those delivery objectives had been achieved.

-        The Priority Two Co-Sponsor added that a lot of the additional work in development was the engagement with the Health and Inequalities team and the collaborative working looking at the new HWS outcomes metrics, the HiAP approach and the data sets to build up a population-based framework that would be relevant at place and neighbourhood levels; highlighting where the variations are for each of the priorities and to use the Mental Health Investment Fund to provoke targeted interest and investment in communities based on the evidence gained. The renewed leadership and collaborations were positive and significant progress had been made over the past six months, she thanked colleagues for their support.

5.    A Board member noted that the indicators regarding Priority Two approved in the previous item provides some of the concrete outcomes relating to prevention and early intervention for example.

6.    A Board member noted that the approach set out was clear and structured, however in terms of the capacity to deliver against the ambitions she asked at what point would there be an evaluation of the capacity within the system to deliver against the Mental Health Improvement Plan and at what point would a decision be taken to commit resources to increase that capacity, whether through academies or through a recruitment and retention programme or support for the VCFS. Ensuring that once a set of outcomes had been committed to, the direction of travel would be able to maintain that delivery working to a sustainable capacity.

-       The Independent Chair (Surrey MHSDB) explained that an initial phasing exercise had been undertaken and the next stage would be to look at the detail and to see what the MHSDB as a partnership consider to be the priority areas, what the resourcing is which is linked to each provider and what might need more focus; difficult decisions might need to be made.

7.    A Board member agreed that the metrics should be the bedrock of how to test whether the mental health system is improving. Undertaking cohorting or subsetting could be a possibility even for those metrics that do not specifically look at mental health, such as looking at the life expectancy for those with a learning disability for example compared to the general population, to get a sense of the inequalities. He noted that there would also be a mental health policy and activity board pack which would inform how the MHSDB would operate. He noted that the MHSDB is committed to identifying the changes it wants to make and ensuring that the resources are in place and are used as effectively as possible; both the local authority and the NHS had a clear commitment to invest in the mental health system. As a leadership group it would be vital to get the right balance between the level of ambition and the pace of change.

-       The Chairman noted that the £13 million funding within the Mental Health Investment Fund for early intervention and prevention was crucial; and thanked the Independent Chair (Surrey MHSDB) and the Priority Two Co-Sponsors for taking this large piece of work forward.

8.    A Board member reflected on what children and young people tell SCC the difference that they want to see: that they want to wait less time to be assessed and they want to wait less time between being assessed and being treated; a measure of success therefore would be if that waiting time and numbers of young people waiting were to shrink. Another measure of success would be if a presenting problem at the start of any treatment has been improved by the end of any treatment. She noted that it would be vital to look at those aggregate measures across the system.

9.    The Chairman commented that bearing in mind the impact that people with mental health issues has on policing, he asked whether the Independent Chair (Surrey MHSDB) would be happy to have a policing representative on the MHSDB.

-       A Board member noted that she would welcome policing representation on the MHSDB. She noted that as the national lead for Police and Crime Commissioners on mental health she was keen to learn more. She noted a worrying conversation with Surrey’s Rape and Sexual Abuse Support Centre (RASASC) this week about men, women and children with serious sexual trauma not able to access the trauma informed services they need. That is a vulnerable group who being sent for Cognitive Behavioural Therapy, whilst well-meaning, is in fact retraumatising to them.  

RESOLVED:

1.    Approved the draft terms of reference of the new Mental Health System Delivery Board (Appendix 2); and

2.    Noted the contents of this update and endorsed the proposed next steps.      

Actions/further information to be provided:

1.    The Independent Chair (Surrey MHSDB) and the Priority Two Co-Sponsors will look to ensure policing representation on the MHSDB, liaising with the Board member (Lisa Townsend) on the matter.