Agenda item

Purpose of the item:

Right Care, Right Person (RCRP) is a national Police led initiative that is an operational model developed by Humberside Police.  A national partnership agreement was signed by NHS England, The Department for Health and Social Care and the National Police Chiefs Council.

Right Care Right Person is designed to change the way the emergency services respond to calls involving concerns about mental health.

This paper sets out the arrangements in place between the health and social care sectors and Surrey Police in response to the roll out of RCRP in Surrey.

Witnesses:

Mark Nuti, Cabinet Member for Health and Wellbeing, and Public Health

Liz Uliasz, Director for Mental Health, Emergency Duty Team (EDT) and Prisons- Adults, Wellbeing and Health Partnerships (AWHP)

Simon Brauner-Cave, Deputy Director of Mental Health Commissioning- NHS Surrey Heartlands ICB (SHICB)

Alexander Jones, Consultant Nurse Mental Health crisis care, Surrey and Borders Partnership (SaBP)

Helen Wilshaw-Roberts, Strategic Partnerships Manager- South East Coast Ambulance Service (SECAmb)

Maria Millwood, Board Director, Healthwatch Surrey

Key points raised during the discussion:

1. The Chairman raised that it was World Mental Health Day and noted that the theme was workplace mental health. The Director for Mental Health, EDT and Prisons, and the Deputy Director of Mental Health Commissioning (SHICB) provided a brief introduction to the Right Care Right Person (RCRP) report. The Director for Mental Health, EDT and Prisons stated that the police shared their policy procedure. The police delayed the RCRP implementation on request when Surrey County Council (SCC) were planning to involve the Children, Families, Lifelong Learning and Culture directorate, and that those under18 years old were not part of RCRP. If a child was involved, the police would deploy as normal. The police delayed by about 6-weeks to give groups time to ensure practice was embedded.

2. A Member asked how the monitoring of RCRP was being managed collaboratively regarding staff training and how issues were dealt with. The Director for Mental Health, EDT and Prisons explained that all organisations did their own training based on information shared by the police. Training was monitored by the bronze, silver and gold groups that continued to meet since RCRP’s implementation. Prior to RCRP’s implementation, the bronze group, looking operationally, reviewed case studies and people’s potential journeys. This escalated to the silver group, where learning was reviewed tactically. Issues were quickly raised with police and data was challenged where necessary.  The Director for Mental Health, EDT and Prisons rolled out training and staff awareness sessions to around 1000 SCC staff, which may be repeated. Prior to RCRP’s implementation, each organisation undertook a Red, Amber, and Green rating at the Silver Tactical group meeting on their readiness for RCRP. The Adults, Wellbeing and Health Partnerships directorate (AWHP) had a dedicated email where staff could raise issues. Organisations created their own guidance for staff, which included a Surrey system agreed escalation process.

3. The Consultant Nurse (SaBP) stated that SaBP socialised their staff and reviewed training provided by the police. He took part in the bronze and silver meetings, where case reviews and issues around RCRP were assessed and corrected. Outside of these meetings, SaBP had regular interfaces, where good practice was discussed to ensure that things worked well and that people received the support required from the right service. SaBP went back to their teams to ensure awareness of the escalation procedure was clear, and issues were raised in the Bronze group. Initial RCRP learning with the police was around welfare checks, where people may be used to online reporting for welfare checks. SaBP communicated with teams that, to follow the RCRP process they needed to talk with a call handler who would use the THRIVE (threat, harm, risk, investigation, vulnerability and engagement) risk assessment model.

4. The Member asked whether face-to-face or online training was undertaken, highlighting the benefit of in-person training. The Director for Mental Health, EDT and Prisons explained that SCC’s training was conducted online to reach more people. Training included an opportunity for question-and-answers and the training pack was shared with staff. In-person training could be explored for future training. The Consultant Nurse (SaBP) expanded that SaBP had a similar approach but had face-to-face discussions in business meetings and governance forums to socialise teams further on RCRP. The use of a Patient Safety Incident Response Framework (PSIRF) was explored to consider how teams could be quickly gathered to re-embed learning.

5. The Board Director of Healthwatch Surrey asked about the relevant training being integrated across the whole system, including voluntary organisations such as Healthwatch Surrey. It was noted that Healthwatch Surrey saw an increase in people contacting their helpdesk in crisis, and not wanting to go where Healthwatch signposted them. The Director for Mental Health, EDT and Prisons explained that SCC encouraged the police to contact voluntary organisations. The police rolled-out some training for some voluntary sector colleagues. SCC had asked the police to contact East Surrey care providers. If Healthwatch Surrey felt there were gaps in the training, this could be relayed to the police and the silver group to encourage it to be looked at.

6. The Chairman asked how the staff at the South East Coast Ambulance Service (SECAmb) were managing the RCRP initiative and how it was monitored. The Strategic Partnerships Manager (SECAmb) explained that RCRP had so far not proven to represent a noticeable increase in police activity re-directed to ambulances. The escalation process supported providing the discussion where alternative agencies attendance was required. SECAmb saw an increase in mental health calls, but it was difficult to associate it directly with RCRP. SECAmb has a clear process to manage incidents from a mental health call that may be a result of RCRP. Escalations were made from operations by raising an internal DATIX (incident reporting mechanism). DATIX’s were and continue to be monitored for specific case reviews. Partner colleagues were informed of case reviews, either for a specific case or at weekly Bronze group meetings. One recurring theme was when ambulance crews encountered a patient with a ‘history marker’ for mental health concerns. SECAmb anticipated a police presence prior to contacting the patient, but sometimes the police did not respond as it was viewed as a perceived risk, not an actual event. When the emergency operations centre felt an incident required police presence, they used the Surrey system agreed escalation process. Police assured NHS Trusts that if crews experienced violence or aggression, they would respond. If SECAmb noticed incidents that could have been better dealt with, this would be relayed to partner group forums, specifically the weekly Bronze group. If a case review warranted earlier discussion, SECAmb gathered with partners to do so for a specific case review.

7. A Member asked what increase in support had been required since RCRP’s implementation. The Strategic Partnerships Manager (SECAmb) explained that RCRP had not shown a noticeable increase in police activity redirected to ambulances but that RCRP implementation has improved communication between agencies. The presence of specific policies around RCRP and an escalation process between the contact centres indicated when a different response was required. There were cases where SECAmb believed there was a need for a police presence for mental health related calls, particularly if a patient had a history marker for mental health. If there was an immediate risk to the patient or to staff, or if staff experienced violence or aggression, the police would respond, facilitated by the emergency operations centre and the contact centre. Some DATIXs showed times where SECAmb arrived on the scene, requested police assistance, but had not always received that response. When SECAmb decided a Section 136 under the Mental Health Act was required for a patient, SECAmb would escalate for police support.

8. The Member asked about Surrey’s support services and further increases needed after RCRP’s implementation. The Deputy Director of Mental Health Commissioning (SHICB) explained there was consistent messaging in the Silver Tactical group from stakeholders that additional demand was not yet seen across Surrey’s services. The Bronze group was sampling calls to the police to see if there was activity not visible to Surrey’s services and what some of the longer-term implications might be.

9. The Member asked if there was a specific contact point to hand over a patient at the hospital and end police involvement. The Consultant Nurse (SaBP) explained that if the police had concerns around someone’s physical health the individual could be taken to an emergency department, and that highlighting RCRP was not exclusive to mental health. Other areas that implemented RCRP had sought additional funding to support the transfer from police to different services, for example Kent and Hampshire commissioned a private ambulance service to wait with people. Surrey has not sought additional funding. There were existing systems in Surrey to monitor Section 136, such as sub-groups that reviewed police activity around Section 136 use and body-worn footage. Police Officer’s decision-making was explored and whether advice had been sought from a registered health professional before a Section 136. Surrey did not have a system for a handover process, so officers would still attend emergency departments. It was for police officers and the emergency departments to decide when there could be a safe handover. In SaBP’s Health Based Places of Safety, SaBP sought their own staff and mental health professionals to take over from the police. There was work to try to ensure there was space in the Health Based Places of Safety to prevent conveyance to emergency departments and help discharge the police back to the community quicker.

10. The Chairman asked about SECAmb’s face-to-face ‘Conflict Resolution Training’ (CRT) for frontline staff, how much staff this covered, how the extra workforce responsibility was manageable without additional resources, and what reporting on the training was in place. The Strategic Partnerships Manager (SECAmb) explained CRT had covered at least 700 staff. Complete roll-out of CRT would take a further 12 to 18 months due to staff rota requirements. CRT was adapted from police training with a focus on threat assessment, removal from situations and calling for help. Clinical restraint, such as a soft hands-on approach instead of physical restraint was a training focus for SECAmb’s staff. Staff assault was a reducing trend in recent months, which felt like a correlation with CRT. Approved Mental Health Professional (AMPH) services and SECAmb collaborated to provide mental health training to increase frontline staff’s understanding to support themselves in highly emotional, complex situations. Other mental health initiatives included mental health first aid, ASIST (applied suicide intervention skills training) to support frontline services with complex mental health patients. Around 500 to 600 staff members went through this training in 2024. Additional resources were not yet needed for the additional Mental Health activity post RCRP rollout. Ambulance crews had an operational team leader for support if they were struggling on-scene.

11. A Member referred to the end-to-end reviews conducted when an appropriate responding agency was not initially identified, potentially leaving a vulnerable person without the needed care. Regarding these cases, which were minimal, the Member asked where the appropriate agency was not identified, what lessons were learned and shared. The Strategic Partnership’s Manager (SECAmb) explained that the DATIX process identified incidents where SECAmb had concerns for patient safety or how it was managed in the instant review. Some concerns were recently seen and some DATIX was raised about a cohort of patients seen by ambulance crews that were deemed to have capacity over their own decision making and did not want an intervention. At times, the only option was to leave these patients at home with a safety plan. Some cases were emerging where patients may require a specific care plan to be reviewed and discussed at a multi-agency level. Through collaboration between agencies and the police, SECAmb focused on how individual specific care plans could be improved to create a clear plan for all agencies supporting a patient. The use of a Section 136 was reviewed when the patient had capacity not wanting to go to an emergency department but SECAmb felt it was in the patient’s best interest. In this case, the escalation process was utilised for police attendance. SECAmb also had a partnership review meeting scheduled to consider reviewing and amending current guidance through specific case learnings.

12. The Vice-Chair referred to data provided by Surrey Police highlighting that in the first 13-weeks of phases one and two there were over 4000 RCRP related calls. Of these, 1,562 did not meet the criteria for a police response. The Vice-Chair raised that this felt concerning for residents, who were used to a police presence during a mental health crisis. The Vice-Chair asked how staff were managing without a police presence, adding that the police often created an aura of calm and authority. The Vice-Chair also asked how the fire service could support RCRP. The Director for Mental Health, EDT and Prisons stated that the Surrey Fire and Rescue Service (SFRS) were involved in the planning, the Silver group’s Tactical meetings and her task and finish group. SFRS were involved in the health and well-being visits, and in risk assessing. Some SFRS staff attended the RCRP training. If the police were not deployed to a situation, people should be provided with an appropriate contact. The police’s flowchart informed call handlers of appropriate contacts for different situations. For AWHP, a main concern was the welfare visits and how that would impact, and the focus was on a change in practice, using a process and doing all they could before going to the police. They have not seen a sudden influx at present.

13. The Consultant Nurse (SaBP) raised that SaBP helped teams working with someone from a mental health perspective focus on contingency and safety planning at an early stage, including consideration around how to ensure the person’s support network was well joined-up, especially regarding welfare concerns. Police attendance could sometimes be containing and supportive, but it could also feel agitating and intrusive for some due to the context of a situation but not necessarily because the police did anything wrong. SaBP’s call handlers had floor walkers for the first 6-months of RCRP’s phase 1. This was effective as it allowed call handlers to draw on the officer’s additional experience in working with people’s differing needs. Call handlers were instructed to ensure there was a handover of duty and a clear pathway in place even if there was not a police deployment to the scene at the time.

14. The Deputy Director of Mental Health Commissioning (SHICB) added that SHICB had commissioned mental health response vehicles. This was not a blue-light service, but a year’s pilot and would be staffed by SaBP clinicians. The Vice-Chair raised interest in the mental health response vehicles. The Deputy Director of Mental Health Commissioning (SHICB) explained that the mental health response vehicles were separate from RCRP. It was a programme within the NHS, inside the NHS long-term plan. The vehicles were being varyingly introduced across the country as non-blue-light responders to mental distress in the community. The model varied depending on locality. Commissioning and mobilisation of the vehicles had started. Vehicles would be staffed by 2 people, providing a clinician on-scene to provide a therapeutic environment with reassurance, support and intervention. The Member asked if SHICB had received extra funding for the vehicles. The Deputy Director of Mental Health Commissioning (SHICB) confirmed there was additional funding through crisis funding. The vehicles were a test as there was not the data to indicate a need which created difficulty to commission the vehicles. Responses would be collated regarding whether the vehicle was a therapeutic environment rather than any other vehicle and it was agreed to report back to the committee on this data.

15. The Consultant Nurse (SaBP) added that Surrey’s mental health response vehicles would be piloted in Guildford and co-crewed by mental health staff, with close links with SECAmb for deployment. Testing the vehicles over the year was important to ensure understanding on their added value and compare with existing areas that co-crewed the vehicles with ambulance and mental health staff, such as in London and Hampshire. The Vice-Chair responded that the committee would be very interested to learn how that pilot progressed.

16. A Member asked what some of the challenges were around ensuring Safe Havens were effectively communicated to increase public knowledge of them, and if it would be manageable. The Deputy Director of Mental Health Commissioning (SHICB) explained there were significant challenges but considers them to be manageable and there was a plan in place. Changing the way police operated on the ground around Safe Havens and changing their behaviour was a challenge. A challenge was getting another organisation to cascade information down. Time was spent speaking to strategic side of the police force to engage them in workshops with the Safe Havens to describe what they did and how they could be used and develop communications and effective ways of working. There was a lot of police staff turnover, which meant regular communication with the police was important. A suggestion was to look at a physical resource for the police to refer to such as on personal devices or in police cars. Consistent communication needed to be led partly by the police and SHICB’s providers. This would be part of the review and SHICB’s commissioning of Safe Havens going forward.

17. The Chairman asked if there was confidence as part of SCC’s task and finish group exercise that all risks were understood, and if there was a process in place for incorporating lessons learned. The Director for Mental Health, EDT and Prisons explained that the task and finish group included various partners such as Public Health, Legal, SFRS and colleagues in the Children, Families and Lifelong Learning and Culture directorate. SaBP shared their draft staff guidance with SCC who used it as the basis for their staff guidance, providing a consistent approach. It was about consistent understanding of the risks and understanding the mitigations. The Director had met with the County Council lead, some of the sub-groups and some task and finish group members to ensure risk awareness was robust. There was confidence and lessons-learned was an ongoing process through the different bronze, silver and gold groups. It was a task to review the guidance and training offer, after RCRP had been in place for 6-months, and there was always room for improvement and learning.

18. The Consultant Nurse (SaBP) noted that involvement from a Surrey Police superintendent who reached out to partner agencies and continued to be accessible through the process helped SaBP to have transparent conversations about concerns at a level where it felt actions could be taken.

19. Regarding Safe Havens and Safe Harbour, the Board Director for Healthwatch Surrey asked if the patient’s experiences were collected under the newer model and measured to understand the impact on vulnerable people, improve services, and involve people in reviews of these services. The Deputy Director of Mental Health Commissioning (SHICB) confirmed this. SHICB was starting to review the Safe Havens. The Safe Harbours were new initiatives that provided daytime support and were not being reviewed yet. Patients would be involved in Safe Haven reviews. SHICB had a group of people that did co-productive insight work that were suspected to be commissioned to work alongside service users to drive out those experiences. The commissioning team was going through existing user experience and service insight as part of their operational routine monitoring recognising there is quite a lot of work to do there.

20. The Vice-Chair asked if SHICB was evaluating and hoping that the outcomes for the patient would be better under this scheme. The Deputy Director of Mental Health Commissioning (SHICB) confirmed this and explained that Safe Havens were outside RCRP and were core provision services under the NHS’s long-term plan to look after people, prevent people getting less well and escalating into crisis. SHICB was looking to improve these services and ensure there was good learning across the different Safe Havens.

21. The Chairman explained that Safe Havens were an extremely valuable provision and RCRP pushes our thinking in that direction. The Chairman asked about future challenges and raised an issue around change and the pressures created on staff. The Chairman asked if there had been changes in staff turnover and if any risks would result in more work and resource requirements. The Consultant Nurse (SaBP) explained that a significant challenge was that the evidence base regarding what worked for people during a crisis was still developing. SaBP had evidence around things such as crisis resolution and treatment teams regarding initiatives such as Safe Havens, Safe Harbours and crisis houses, which was still being built upon. SaBP need to closely observe each of these developments and how they interfaced with partner agencies such as the police, regarding RCRP. More collaborative partnerships with the third sector and other providers were important. When people presented in crisis, components could be different, such as mental health, domestic violence, financial and housing struggles. Coordinating these different strands with different organisations could be challenging. Some work with the ‘Crisis Care Concordat’, was to try to ensure there was coordination with approaches and look at how organisations were evaluating the impact on the people they served. Regarding staff, particularly paramedics involved in a lot of trauma and stressful situations, recognising the need to consider how to ensure the development of effective and collaborative working, that there was a robust system around staff to ensure they were protected and that there were provisions in place to support staff.

22. The Director for Mental Health, EDT and Prisons added that frontline AMPHs who also experienced trauma worked closely with the police and noted the importance to look after staff and their wellbeing. For example, there were reflective practice sessions, and it was ensured staff had access to a de-brief and to Employee Assistant Programmes. Staff turnover was monitored, and exit interviews were conducted. For some staff, particularly working on the mental health frontline for a long time, they needed a change or to take a break. AWHP had to be mindful of demand and complexity increases for their staff.

RESOLVED:

1. It is recommended that all parties agree a common approach to monitoring and reporting with an emphasis on identifying and preventing vulnerable people being subjected to less-than-optimal support.

2. It is recommended that the delivery performance of staff training in changed processes is monitored and published, together with actions taken to maximise the uptake of training

3. Staff welfare is a major consideration; the committee would like to be updated on how the (non-blue light) Mental Health responder service vehicles are operating and receive information on that.

Actions/requests for further information:

1. Director for Mental Health, EDT and Prisons (AWHP) to review opportunities to conduct in-person staff training.

2. Director for Mental Health, EDT and Prisons (AWHP) to contact the Silver Group/ Police colleagues and encourage them to review any potential gaps in the training offered to voluntary organisations, such as Healthwatch Surrey.

3. Deputy Director of Mental Health Commissioning (NHS Surrey HeartlandsICB) to update the committee on the learnings gathered from the pilot mental health response vehicles (non-blue light responder services) being conducted.

Meeting paused for a break at 1.02pm

Cllr Carla Morson and Cllr John Furey left the meeting at left the meeting at 1.03pm

Meeting resumed at 1.24pm