Agenda item

Purpose of the item: To provide an update to the Adults and Health Select Committee on progress since the October 2022 meeting.

Witnesses:

Mark Nuti, Cabinet Member for Adults and Health

Liz Bruce, Joint Executive Director Adult Social Care and Integrated Commissioning

Liz Uliasz, Chief Operating Officer

Lucy Gate, Public Health Principal

Jonathan Perkins, Independent Chair Surrey Mental Health System Delivery Board

Graham Wareham, Chief Executive - Surrey and Borders Partnership (SaBP) NHS Foundation Trust

Professor Helen Rostill, Deputy Chief Executive - Surrey and Borders Partnership (SaBP) NHS Foundation Trust

Jonathan Fisher, Chair – Surrey Coalition of Disabled People

Maria Millwood, Non-Executive Director – Healthwatch Surrey

ImmyMarkwick, Mental Health Lead, Independent Mental Health Network

Patrick Wolter, Chief Executive – Mary Frances Trust

Key points raised in the discussion:

1.    The Chair asked about unmet need in the system and what plans there were to improve data collection. The Deputy Chief Executive stated that current modelling showed that only a third of need is being met in Surrey in line with national trends so there was a lot to do and that the Joint Strategic Needs Assessment stated the need for improved measurements of need based on studies within Surrey.  There also needed to be more focus on reporting and measuring local needs accurately instead of the high level of local variations in the level of reporting. There was a willingness in the system to work together to identify this level of data and the impact of interventions. This would help to target resources more effectively. The Chief Operating Officer advised the Committee that Adult Social Care was developing a business case to allow them to increase their staffing levels to meet need.

2.    In response to the witnesses’ emphasis on a holistic approach to mental health a Member asked for their views on the Surrey Police and Crime Commissioner’s statement that Surrey Police would not be attending all mental health incidents. The Chief Executive of SaBP said that there was ongoing joint work with Surrey Police and recognition that the force would continue to be involved when their unique skills were appropriate. There were plans to allow the Police not to have to wait with people in a state of distress in Emergency Departments by creating mental health clinical decision units. Partners would work through the new guidance for Police attendance.

3.    A Member queried the impact of social media on service demand. The Chief Operating Officer reported that they had seen an increase in referrals for children and young people. Social media could be a factor in this but could not directly attribute social media to these referrals. The Chief Executive of SaBP agreed that social media could be an aggravating factor but not an exclusive reason in its own right.

4.    On the topic of the national funding allocation the Independent Chair advised that when developing the Mental Health Improvement Plan they chose to prioritise other areas they could influence within Surrey rather than on lobbying for greater funding from central government. It was important to have good data in Surrey to be able to negotiate on the funding in the future. The Public Health Principal commented that it was a recommendation of the Joint Strategic Needs Assessment to improve data on need and Public Health would be working with the Surrey Data Hub on Serious Mental Illness (SMI) registers using a dedicated data analyst.

5.    A Member raised the funding of General Practice Integrated Mental Health Services (GPimhs) in the county. The Deputy Chief Executive explained that this was the last year of national Service Development Funding (SDF) after five years of specific funding. After this is it will become part of the baseline budget allocation or business as usual.

6.    Support for those residents whose mental health has been affected by the cost-of-living pressures and food insecurity is available. The Public Health Principal said there was place-based prevention work called ‘Toolkit C’ to engage residents to unpick key challenges then work with existing services.  There had been evaluation to ascertain the reach of services to food banks and benefits advisers.

7.    The Chair of the Surrey Coalition of Disabled People raised an issue about cuts to direct payments in recent statements. The Joint Executive Director Adult Social Care and Integrated Commissioning apologised and said she would take this issue away and respond in detail to the Coalition. The Vice-Chair reported that she had heard of this issue from residents as well.

8.    Regarding suicide a Member asked what was being done to identify causes, the measures to reduce suicide and support those at risk. The Public Health Principal referenced the real-time surveillance database for suicide and suspected managed by Surrey Police that is reviewed daily and a fortnightly learning review of cases of suicide or suspected suicide. An annual thematic review was underway and some initial findings were an increase in suicide or suspected suicide in adults with long term conditions. The 2023 Suicide Prevention Strategy sets out preventative interventions.

9.    As a follow up the Member also raised lessons learned from recent coroner criticisms and the status of the Abraham Cowley Unity. The Chief Executive said coronial criticisms were part of their usual learning process and the Abraham Cowley Unit was expected to complete in Autumn 2024.

10.  A Member asked about data for attempted suicide with particular reference to the LGBTQ community. The Public Health Principal referred to the real-time surveillance database but said this only tracked cases known to the police and the definition of attempted suicide was a challenge so Public Health were procuring a database that would collect other data from other partners such as social care and SaBP to improve the rigour of data..

11.  Witnesses were asked about workforce recruitment and retention issues. The Chief Operating Officer mentioned the Think Ahead programme which the Council had made a bid to for 10 student social work places. It received 5 which would mean more mental health social workers and internally Adult Social Care had 20 apprentices due to become newly qualified social workers, many with an interest in mental health, this year as well. The Chief Operating Officer also mentioned that they would be developing a retention strategy to understand why people chose to leave social work. Adult Social Care would work the Integrated Care Board (ICB) on workforce recruitment and retention as this was not just a social care issue. The Deputy Chief Executive mentioned the importance of the United Talent Strategy and being able to grow our own staff, especially a career pathway for those with lived experience, rather than rely on international recruitment.

12.  The Vice-Chair queried Surrey’s mental health service delivery as compared to other systems. The Joint Executive Director has asked for research to be done in this area and what ‘good’ looks like. The Cabinet Member met with the Chief Executive of the charity Chasing the Stigma that ran a nationwide Hub of Hope online system that tracks local mental health services based on an individual’s postcode which the Council was considering adopting to aid with navigating the complex pathways into mental health services. In Surrey, officers had been working with the Mental Health Alliance to understand needs around first contact. The Council was looking to commission a lay phone line to allow direct escalation to SaBP and de-escalation for those who have had contact with services. 

13.  The Chief Executive of the Mary Frances Trust commented on the relationship between the voluntary sector and statutory organisations saying they felt involved and supported, their voice was being heard in the designing and delivery of services. Financial stability and contracts across the sector remain key challenges for the sector but their expertise was valued. 

14.  The Chair raised the related topics of discharge, the Home First service and bed management. The Chief Operating Officer explained there were a number of issues affecting discharge flow: the level of demand and finding the right providers to work with more complex cases. The Council and the Mary Frances Trust had created a discharge hub to plan patient’s discharge from an early stage and help people to return to their own homes. Adult Social Care had also launched a Mental Health Housing protocol across Surrey district and boroughs with SaBP. The Deputy Chief Executive explained that Home First was fairly new set up as an admission avoidance scheme in the community to wrap services around individuals with high intensity needs and support their recovery. It has capacity for around 60 people and there was evidence that the service was beginning to prevent admissions. The Chief Executive of SaBP stated that learning from other parts of the country to amend pathways and the freedom of using in-house beds at the North West Hospital versus private beds was aiding bed management alongside the already mentioned mental health clinical decision units and the discharge hub.

RESOLVED

The Select Committee recommended:

1. To continue to provide support to residents struggling with their Mental Health as a result of the cost-of-living crisis.
2. To thoroughly examine the root causes of suicide amongst Surrey residents, an to utilise these findings to formulate robust suicide prevention measures.
3. To ensure effective, transparent, and coordinated Continuity of Care for residents with Mental Health Needs.
4. To continue to develop and share data on geographical and clinical areas of menetal health need, and to develop robust measurements on comparing of residents being treated relative with those with unmet mental health needs.
5. To continue to improve the Bed Management Operating Model so as to improve discharge and flow.
6. To expand the adoption of place-based approaches so as to provide targeted support to local areas with higher mental health needs including protected characteristics and ethnic characteristics.
7. To expand the use and reach of the HOMEfirst approach, and to ensure adequate allocation of resources for this.
8. To ensure sustainable commissioning arrangements to support VCSE partners providing Mental Health Services.