Agenda item

Purpose of the item:

1.         This report has been prepared for the Adults and Health Select Committee.  It reviews the number of people of working age in Surrey who are not working because of mental health issues.  It will explore the issues that have led to this and how these issues can be addressed to deliver improvements for Surrey residents, especially those who experience the poorest health outcomes within the 21 Health and Wellbeing Strategy Key Neighbourhoods.

2.         It reviews current data to ensure that the most urgent mental health needs are identified and sets out what is being delivered to support those who are some of the most vulnerable people within the community.  This is to ensure a greater focus on reducing health inequalities, so no-one is left behind.

In attendance:

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), Surrey County Council (SCC)

Lucy Gate, Public Health Principal, Mental Health Surrey County Council (SCC)

Rebecca Brooker, Communities and Prevention Lead, (AWHP) Surrey County Council (SCC)

Lorna Payne, Chief Operating Officer, Surrey and Borders Partnership NHS Foundation Trust (SaBP)

Georgina Foulds, Associate Director for Community Transformation, leading Surrey Heartlands Community Transformation Programme (SaBP)

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

Key points raised during the discussion:

1. The Public Health Principal provided a detailed introduction to the report.

2. The Chairman asked what the data explains about the number of people of working age in Surrey who were not working because of mental health issues, what are the gaps in the current provision and how these gaps could be filled. The Public Health Principal explained that in Surrey there were around 100,000 fit notes for people signed off from work due to ill health, the majority of which were mental health or MSK (musculoskeletal) related. It was not known how many of these get repeat fit notes, but it showed a population level need. The Communities and Prevention Lead, (AWHP) added that steps were being taken to address gaps in understanding to provide a good service to residents and help those most in need. Research had been done with people living in work poverty, people furthest from the labour market and with employers to understand what this meant to them. Mental health emerged as a common theme in this work. Specific and targeted work was being undertaken around impacts on employment, looking both at the impact of sickness absence for businesses’ economic productivity and resulting effects on SCC’s system in terms of service demand and waiting lists, and the impact on individuals and wellbeing as well as qualitative and quantitative research on what experiences have been. Planned ways to engage with people on this included connecting into things such as Men’s Pitstops (mental health group). SCC would also look at their own staffing and how they can understand sickness levels and how that impacted on local productivity.

3. The Chairman raised that careers and satisfying employment were key to dealing with mental health issues, and asked what focus was on skills and career development and what the thinking was on that direction. The Communities and Prevention Lead, (AWHP) explained SCC was working in a person-centred way, recognising every individual was different and wanted different things out of employment. There were two vanguard programmes through Department of Work and Pensions funding (DWP), which gave SCC £12m to support people into good quality work. This was being delivered across the system in partnership with health and voluntary sector colleagues, and district and boroughs. Both programmes had a person-centred approach with residents and included provision to work with employers to encourage workplaces to have structures and support for staff’s mental health. Work was done around work poverty to understand how mental health’s impact on people’s ability to move into strong and healthy careers. A programme was put in place called ‘More and Different’ which was created to identify entry level roles and how they could develop into long- term careers. SCC created spaces for schools and employment support provision to come together in a network to enable practice improvements and support people back into good quality work in a system way.

4. The Director for Mental Health, EDT and Prisons added that AWHP had the adult social care academy which looked at opportunities for SCC’s staff such as preceptorships for newly qualified therapists and occupational therapists (OT), apprenticeship programmes into social work and OT training, assessed and supported year in employment (ASYE) for newly qualified social workers. Career progression for non-registered staff that might not was to be a social worker was also looked at. SHICB also had an academy that SCC linked in with to look more widely across other cohorts such as social care providers.

5. The Vice-Chair recognised that improvements were underway but asked how it was discovered that things were being done differently compared to before due to the Improvement Plan, and if examples could be provided. The Communities and Prevention Lead, (AWHP) explained that in terms of innovation, ‘Work Wise’ and ‘Work Well’ were innovation programmes with the idea to test, develop practice and learn. There were opportunities to test new things locally and inform national policy. SCC had introduced time-unlimited support for people. The ‘Work Wise’ programme could be accessed for as long as needed. SCC was introducing rapid support through the ‘Work Well’ programme. When people were off work under a fit note, the ability to access support was limited and rapid support would help get to people earlier in their mental health experience and see how this prevention made a difference. There was national and local evaluation ongoing for these programmes.

6. A Member referred to the £6m investment from DWP to help innovation programmes and asked what mechanisms there were to utilise this, and how SCC would demonstrate how it would demonstrate how it was being utilised. The Communities and Prevention Lead, (AWHP) agreed to provide the committee with more detail on the work of the innovation programmes. Both the ‘Work Wise’ and ‘Work Well’ programmes were available to all Surrey’s residents and in different locations to be accessible. The programmes support included someone to help a person navigate a range of holistic support services, such as skills development and mental health support. There was evaluation in place to help deliver these programmes to a high standard as well as understanding their own processes and learning what was and what was not working.

7. The Vice-Chair raised that districts and boroughs were in receipt of the UK’s prosperity fund and asked if this fund was being used to help SCC with the innovation programmes, and if there was coordination with the districts and boroughs. The Communities and Prevention Lead, (AWHP) explained that SCC allowed districts and boroughs, who had autonomy of their Shared Prosperity Fund, to do what they felt was right for their residents. This was done in an environment where SCC could collaborate with them. SCC was developing a worker health approach, aiming to bring all people doing things together into one space to build understanding of all of Surrey’s work and health offer. This meant SCC could maximise what the district and boroughs were doing through things such as the Shared Prosperity Fund. SCC were working together with districts and boroughs in a range of ways on the ‘Work Wise’ and ‘Work Well’ programmes where possible.

8. A Member asked what the current cost to businesses in Surrey was from staff unable to maintain a role due to poor mental health and if it was too early to show the improvements and comparisons in any one area and what did the data tell us. The Communities and Prevention Lead, (AWHP) explained there was currently not a lot of localised data around this. SCC could see things from national research Part of DWP’s funding would be used to understand the local picture. SCC would gather a snapshot of the local picture and monitor this overtime to see how SCC was making a difference and how it changed based on things, such as new government policies. There were important areas of skill demand in Surrey, such as green skills and health and care skills. Work would be done to understand what this meant locally. The Communities and Prevention Lead, (AWHP) would share the data with the committee when they obtained it.

9. The Chairman asked if there was collaboration with Surrey Adult Learning. The Communities and Prevention Lead, (AWHP) confirmed that they were connected with Surrey Adult Learning as part of their collaborative network and there is more to do on how they can better connect together.

10. Regarding the ‘One System, One Plan’ approach, a Member asked how the data had improved patient reported outcome measures because of the Community Mental Health Transformation programme, and a new place-based Integrated Model of Primary and Community Mental Health Care. The Associate Director for Community Transformation explained that SaBP had achieved the roll-out of the specialist integrated mental health services in primary care across all of SaBP’s footprint. It was important to understand the impact of this and to review improved outcomes for people. SaBP commissioned a company called Unity Insights to undertake an independent evaluation completed in March/April 2024. It had positive findings around improvements in access, experience and outcomes. The report could be shared with the committee.

11. The Associate Director for Community Transformation added that the second phase of the Community Transformation Mental Health programme was a continuation of the work achieved so far. In this phase, integration with places and neighbourhoods was looked at. Whilst they embedded the new primary care service in the primary care networks (PCNs), they wanted to bring together community services with partners to work collectively and address local community needs. In the second phase’s governance structure, working with each place to scope what integrated teams would look like and start to build on what was in place. Pathways forums for all agencies and GPs to come together to discuss how to meet people’s needs, rather than risk a person being bounced around the system was embedded well and received positive feedback.

12. A Member asked what was being done to support people with enduring mental health difficulties in the community, to be kept out of hospital or transitioned out of hospital and helped back into employment, and what is the scale in comparative terms of such problems, and how well are you managing that.  The Chief Operating Officer (SaBP) explained that SaBP provided psychology support such as talking therapies, and secondary care. SaBP was trying to intervene earlier through community-based support. The Associate Director for Community Transformation added that in January 2023 SaBP mobilised a new service called the Home First approach, which was for people who had complex needs to prioritise their attention and resources with the intention to stop people going into hospital as much as possible or reduce the length of their stay. There was 85 people under the Home First approach and undertook evaluations on the approach which provided positive data on supporting people not to go into hospital, reduce the length of hospital stay, and reduction in the use of the Mental Health Act. The impact of the approach, which had so far been positive, was closely monitored. The Deputy Director of Mental Health Commissioning (SHICB) added that because of the Home First Approaches’ positive evidence, SHICB had chosen to invest further resource into the Home First team, particularly to address personality disorder which SHICB currently underprovided for. The second phase of the Community Mental Health Transformation Programme would draw in specialist services to come together and make referrals easier into services through one simple process rather than multiple referrals. The Director of Mental Health, EDT and Prisons added that adult social care’s focus was more on recovery, such as by working with people to identify their goals and help get people back into employment.

13. A Member asked how it could be ensured that the most urgent mental health needs were identified and what was being delivered to support some of the most vulnerable people in communities to ensure a greater focus on reducing health inequalities. Additionally, the Member asked what methods were being used to measure success, what level of success was achieved so far and what more could be done. The Chief Operating Officer (SaBP) explained that according to NHS England’s mental health population needs index, Surrey Heartlands Integrated Care System had one of the lowest levels of population need, but had one of the lowest levels of mental health spend per person, which was challenging. Surrey had a higher-than-average mortality rate for people with severe mental illness, and significant challenges and a high level of inequality for those suffering severe mental illness. SaBP developed a model using patient level electronic records, which found Surrey’s definition of severe mental illness included a broader set of diagnostic codes compared to the Quality Outcomes Framework.

14. The Public Health Principal (SCC) added that work was done with Surrey University to understand Surrey’s population with severe enduring mental health needs. Surrey was recognised as having a low level of need, as needs were calculated based on Surrey’s demographic. The Quality Outcome Framework only included certain coding and diagnosis, so work was undertaken with King’s College London and Surrey University to understand the level of need and some of the wider coding, called ICD-10 codes in secondary care and SNOMED codes in primary care. This had established more than what was available on the Quality Outcome Framework or national estimates, which allowed for population health management work to understand how SCC could target and prioritise interventions. Scenario modelling was done to understand some of the possible high-impact changes for this population and review areas such as Accident and Emergency attendance and hospital admissions. There was a Severe Mental Illness (SMI) Health Inequalities Board and a multi-agency action plan would be explored to support the implementation of the board recommendations.

15. The Chief Operating Officer (SaBP) added that SaBP found around 22,000 individuals thought to fit into the SMI category, whereas on the Quality Outcome Framework only found around 5,700 people. Key neighbourhoods of deprivation had a significantly higher proportion of people with SMI, and there were gender disparities with nearly twice as many women as men in the SMI population but more men with SMI were likely to have more mental health admissions. SMI population had substantially longer A&E waits. Community teams tried their best to support people to live longer in their own homes. Ongoing work with The Richmond Fellowship was important to ensure that people with SMI get work they were good at and interested in.

16. A Member raised the importance of getting meaningful measurements of people’s mental health needs and concerns regarding the equations and coding’s used as it is not completely accurate in identifying peoples lived experiences of those people most in need. The Chief Operating Officer (SaBP) agreed but highlighted diagnosis was sometimes not straightforward and could take time.

17. The Vice-Chair referred to the idea of engaging with employers to encourage the employment of people with mental health issues and asked how much focus there was on working with Surrey’s economy to address the situation. The Chief Operating Officer (SaBP) highlighted work with The Richmond Fellowship who worked with a range of employers and would an important part of recovery in terms of avoiding hospital admission and helping with employment and accommodation. The Associate Director for Community Transformation added that SaBP integrated employment support with their core offer within primary and secondary care. The provider had ‘link workers’, which were embedded in SaBP’s core community services, involved in case discussions and ensuring earlier help for people. SaBP also had good outcome reports from the provider ‘Way Through’. The Vice-Chair suggested it would be proactive to have a programme that sought out employers to help support employment for people with mental health issues. The Director for Mental Health, EDT and Prisons agreed.

18. A Member asked what the benefits would be to residents from the all-age and place-based approach to developing a ‘Mental Health System for Population Health Gain’, which was being developed in the Public Health and Communities team, with Places and other partners, and what the potential issues were. The Public Health Principal explained that the approach involved working with population health management to understand the level of need in different places. This involved working with places across NHS footprints to understand their populations of SMI, common mental health disorders and lower level need such as sleep. It also involved close working between the Public Health, Communities and Prevention team and teams around the community teams to embed interventions such as the ‘How are you?’ Surrey workforce wellbeing programme. Part of this involved supporting organisations to prevent mental ill health and enable access to early interventions and work with communities to strengthen connectivity. The care sector and routine manual workers were being prioritised in the priority neighbourhoods. Once organisations were ready to support mental wellbeing, they could then be supported to employ people who may be more vulnerable. Community resilience was being supported through the team around the community model where a toolkit programme on the 5 ways to wellbeing was used for communities to develop tailored action plans.

19. The Communities and Prevention Lead, (AWHP) added that there was a service that supported employers to take on people with all kinds of disabilities, including mental health concerns, supporting employers to place the person within their team and help the person stay in the role and succeed. There was an offer to all businesses to help improve their understanding.

20. The Vice-Chair outlined that the report stated that the number of people out of the labour market due to ill health was at an all-time high, and in-work ill-health was rising. The Vice-Chair asked if the measures outlined being taken by SCC would lead to a positive outcome. The Communities and Prevention Lead, (AWHP) explained that SCC believed they would bring about the desired change, indicated through the initiatives undertaken and the bid to be national vanguard sites for the ‘Work Well’ and ‘Work Wise’ programmes. The Public Health Principal added that the programmes outlined across the system were evidence-based or evidence-inspired and were being tested which was key. The next step was around how the initiatives would be integrated to understand how the system was working to support populations and identify need. The governance fit in three separate places, and a challenge was to pull this together to understand if the system response was correct and if it can be improved. The Deputy Director of Mental Health Commissioning (SHICB) added that the new 10-year plan expected following Lord Darzi’s report would include more emphasis. Therefore, requests for more funding was expected around employment, as an expected theme was around how the NHS was to support people in the wider economy.

RESOLVED:

The Select Committee noted the contents of this report and the actions being taken by partners across Surrey to address the link between mental health and employment, and the Committee supports the programmes and the ‘One System One Plan’ approach to improving mental health and the economic activity

The committee recommended:

1. Set clear, measurable performance objectives for each of the initiatives being undertaken 

2. Implement effective reporting on the performance objectives

Actions requests for further information:

1. The Communities and Prevention Lead, (AWHP) to provide the committee with more detail on how the innovation programmes, ‘Work Wise’ and ‘Work Well’ were working and the support these programmes offered.

2. The Communities and Prevention Lead, (AWHP) to share further information/data on the work being conducted to understand Surrey’s local picture regarding the cost to Surrey’s businesses and Surrey’s economy from staff unable to maintain a role due to poor mental health.

3. Associate Director for Community Transformation to share the commissioned independent evaluation report on the impact of the specialist integrated mental health services in primary care.