Agenda item

Purpose of the item: To provide the Adults and Health Select Committee with an update on progress and effectiveness of community mental health transformation for adults and older adults with significant mental health needs across Surrey Heartlands ICS and part of Frimley Health and Care ICS (Surrey Heath and Farnham)

Witnesses:

Mark Nuti - Cabinet Member for Adults and Health

Liz Uliasz - Chief Operating Officer, Adult Social Care

Andy Erskine – Deputy Chief Operating Officer, Surrey and Borders Partnership (SABP) NHS Foundation Trust

Georgina Foulds – Associate Director for Primary and Community Transformation, Surrey Heartlands

AneSosan – Community Mental Health Transformation Programme Manager

Colette Lane - Lived Experience Development Lead

Laura Parrington-Neads - Senior Recovery Coach, Managing Emotions Programme

Damien Taylor – Community Transformation Lead for Older Adults

Patrick Wolter – CEO, Mary Francis Trust

Christine Gee – Reaching Out Operational Manager, Surrey and Borders Partnership (SABP) NHS Foundation Trust

Hina Ashraf – Health Project Lead, Surrey Minority Ethnic Forum

Key points raised during the discussion:

1.    The Chairman asked what was the impact of the annual allocation of transformation funding on page 184, Item 11, Table 1 and said that an explanation for each box in the table was required for better understanding. A further discussion took take place regarding sustainable funding for the third sector and The Deputy Chief Operating Officer, SABP committed to come back to the Committee following further considerations of the changes in funding indicated in the table. Action. Deputy Chief Operating Officer, SABP/ CEO, Mary Francis Trust

2.    A Member, in noting the need required to transform and modernise the traditional service model referenced in paragraph 8, pages 182-183 asked what were the pitfalls of the traditional service and how could the new model overcome them. The Associate Director for Primary and Community Transformation, Surrey Heartlands explained that fragmentation had occurred with the introduction of new services and focus was required to ensure that the wide range of services work together across primary and secondary care. The Community Transformation Lead for Older Adults said that from an older adults perspective, the focus was to ensure that there was a wraparound service to provide support at the right time, in turn identifying those that need support earlier.

3.    A Member asked if the cost-of-living crisis had increased poor mental health and in addition to signposting, what steps were being taken to improve mental health for residents struggling with their mental health. The Deputy Chief Operating Officer, SABP confirmed that the cost of living crisis had resulted in an increased and sustained demand at every level. The community transformation work had resulted in more people being seen more quickly. The Associate Director for Primary and Community Transformation, Surrey Heartlands said that since the transformation programme had launched, highly specialised clinicians were in place in addition to partners from social care and the voluntary sector working together to intervene earlier and address increasing need more efficiently.

4.    A Member questioned what was involved with the Managing Emotions Programme carers course referenced in paragraph 30, page 194, how was its effectiveness measured and what had the uptake been to date. The Senior Recovery Coach, Managing Emotions Programmeexplained that the course which began in April 2021 had been aimed at carers for those who found it difficult to regulate their emotions. The course was promoted and advertised on the GP integrated mental health service (GPimhs) and the personality disorder section of the Surrey and Borders website.

5.    The Chairman requested that further information on the initiatives included in the reports be provided to the Committee to include cohorts, location, funding, funding term, key performance indicator (KPI) monitoring, promotion of the initiatives, geography, communications, marketing and reach. The Deputy Chief Operating Officer, SABPcommitted to take this action to provide the Committee with further information regarding the scale and impact of effectiveness of the initiatives. Action – Deputy Chief Operating Officer, SABP

6.    A Member asked what were the timescales for the four 2023 PCN rollouts referenced in appendix 6 on age 219 and had the recruitment been successful to date. The Associate Director for Primary and Community Transformation, Surrey Heartlands confirmed that Redhill and Phoenix had just launched with plans for the remaining three to go live in the next three months, dependant on recruitment.

7.    A Member asked if there was confidence that young people were transitioning smoothly to adult care.The Reaching Out Operational Manager, SABP explained that the workstream included an initiative to provide all young people from 17 years and nine months to 18 years and 3 months with a support worker to support them with their transition from children and young people’s services to adults services or transitioning out of mental health services.

8.    A Member asked what was being done to stop people from being bounced and how effective had this been to date. The Associate Director for Primary and Community Transformation, Surrey Heartlands explained that the new model of integrated primary and community mental health care has a specific requirement from NHS England to address the ‘bounce’ that historically existed for people with unmet need in primary care who were not ‘ill enough’ to be seen by secondary community mental health teams or were too complex for NHS Talking Therapies (formerly IAPT).  Since 2019 the new GPimhs/MHICS PCN teams have been filling this gap, supporting people with significant mental health needs preventing ‘bounce’ back to their GP. Their work includes forming bridging teams with system partners via weekly pathways forums to support adults stepping up or down between primary and secondary community mental health teams, enabling that person to access the help they need without repeat assessments or referral screening between services. The Chairman requested a detailed report with comprehensive data about bouncing. Action - Associate Director for Primary and Community Transformation, Surrey Heartlands

9.    A Member questioned what additional efforts were being taken to reduce waiting times and were the impacts of waiting times on the acuity of peoples mental health conditions being examined. The Associate Director for Primary and Community Transformation, Surrey Heartlands said that under the transformation programme the expectation was for a four week wait in the new model of primary care.

10. The Chairman queried when the Unity Insights report noted in paragraph 35, page 196 would be available to the Committee. The Community Mental Health Transformation Programme Manager confirmed that the first interim report would be ready by the end of April 2023.

11. A Member said that information about explicit criteria through which the measurement of outcomes and effectiveness of the delivery of the programme was required. The Associate Director for Primary and Community Transformation, Surrey Heartlands agreed that there had been a lack of formal evaluation due to the COVID pandemic and now that issues around data being inputted into an interim system had been addressed, there was confidence that more information would be available going forward.

Recommendations

1.    To implement greater flexibility in recruitment so as to take into account and harness the benefits of lived experience in the delivery of this programme.

2.    To support ICB executive recommendations locally and to NHSE for more sustainable funding and contracts for third sector organisations providing mental health services.

3.    To continue to support the Mental health Improvement Plan on reducing the tendency for patients bouncing between services, and to provide future explicit evidence of how the Community Transformation Programme is achieving this within the scope of the programme.

4.    To develop more meaningful data that demonstrates robust work is taking place to support carers who are supporting mental health patients.

5.    To ensure processes are in place to attract and retain both clinical and non-clinical workforce, including experts by experience.

6.    To mitigate challenges associated with transitions for Young People who will continue to require non-urgent community based mental health support and services.

7.    To improve communications, reach, and public awareness of any initiatives under this programme.

Actions/ requests for further information:

1. The Committee requested further explanations for the figures included in each box in the Annual Allocation of Transformation table 1, item 11 on page 184, and for the updated information to include a consideration of the changes in funding indicated in the table. Action. Deputy Chief Operating Officer, SABP/ CEO, Mary Francis Trust

2. Additional information was requested about the scale and impact of effectiveness of the initiatives referenced in the report to be shared with the Committee to include cohorts, location, funding, funding term, KPI monitoring, details about the promotion of the initiatives, geography, communications, marketing and reach. Action – Deputy Chief Operating Officer, SABP