S M P Newton (Executive Member, Adult Care and Health)

MINUTES of a meeting of the HEALTH PERFORMANCE AND SERVICE DELIVERY TOPIC GROUP held on WEDNESDAY 5 SEPTEMBER 2007 at 10.00 A.M.

ATTENDANCE Members

K J Coleman (Chairman), D W Cullen, H Goldberg, N A Hollinghurst, E T Roach

Other Members in Attendance

S M P Newton (Executive Member, Adult Care and Health) D J Hewitt

Officers

Natalie Rotherham, Scrutiny Officer Elaine Gibson, Trainee Democratic Services Officer Mark Jordan, Head of Section, Joint Commissioning Team

Member Apologies

Apologies for absence were received from D Miller, T J Price

MINUTES

The minutes from a meeting on 20 April 2007 were confirmed and signed by the Chairman.

1. HERTFORDSHIRE PARTNERSHIP FOUNDATION TRUST (HPFT)

(A) PRIMARY CARE PILOTS AND SERVICE RECONFIGURATION

Enhanced Primary Mental Health Care Services

1.1 Andrew Thiedeman Assistant Director, East & North HPFT and Judith Watt, Senior Project Manager HPF attended the morning session. Members received a presentation by Judith Watt (JW).

1.2 The group noted that with effect from August the trust had foundation status and would be known as the Hertfordshire Partnership Foundation Trust (HPFT). A formal contract was being signed between the HPFT and the Joint Commissioning Team for the provision of integrated, multi-disciplinary services.

1.3 Enhanced Primary Mental Health Services (EPMHS) were being

1 developed so that care would be provided by a wider range of practitioners (see presentation, Appendix 1). EPMHS aimed to provide rapid access to services and would not replace secondary care services and local counselling services, which JW confirmed would continue.

1.4 Part of the EPMHS would involve practice-based commissioning (PBC). GP practices were being piloted as “super-surgeries” in some areas. There were pilots underway in Watford, Letchworth, St Albans and Stevenage. The way that PBC would be organised across the different areas in the county was being worked on. The needs of particular locations would require an adaptation of the model, but this would be based on a core consistent model, applied flexibly.

1.5 The aim of developing EPMHS was to bridge the gap between primary and secondary services and to provide a more efficient assessment process so that only one assessment was needed, not several. JW stressed that there were no new resources and that funding was being moved around, although there was some ‘pump- priming’ from practice-based commissioning.

1.6 In response to a question from a Member relating to public consultation, JW commented that the proposals for EPMHS fully accord with the Investing in Your Mental Health Strategy (IIYMH) and that these proposals were the implementation of the IIYMH Action Plan.

1.7 There was discussion on the importance of public awareness of how to access services. JW confirmed that there would be a communication plan. Also discussed was the development of a central control of records across the county, a patient master database that could be accessed by GPs and other service providers, within the parameters of the Data Protection Act.

1.8 The Executive Member asked about the financial implications of EPMHS and whether there would be a ‘safety net’ for end users. It was noted that there should be no overall financial savings against community based Mental Health services as a result of service reconfigurations and this had been made clear to HPFT by commissioners.

1.9 With regard to the ‘safety net’ the group were advised that, during the transition, service providers would ensure that service users did not slip through the net and that there would be ready access back to services. The focus would be very much on developing a preventative strategy.

(B) SERVICES FOR OLDER PEOPLE AND ACUTES

2 Repatriation of Mental Health Services for Older People

1.10 Gerard Breen HPFT Sector Manager, North & East Herts, Sally Hickman HPFT Head of Development & Partnerships, Mental Health for Older People and Keith Moullin, Assistant Director, Mental Health for Older People, attended the morning session.

1.11 Members received a presentation from Gerard Breen (GB) on progress with repatriation of service users back into county who had previously received care at Princess Alexandra in Harlow, or Chase Farm in Enfield (see presentation attached, Appendix 1). Continuing care patients would be repatriated by April 2008. Once the repatriation was complete care would be delivered within Hertfordshire’s boundaries and savings made from the purchase of out-of-county beds would be ploughed back into locally accessible services and into outreach work in service users own homes. Savings would fund one full-time consultant, to be in post by October 2007, two psychiatric nurses and two social workers.

1.12 In response to question from a Member GB confirmed that physical health needs were assessed, in addition to mental health needs, and that there was liaison with local GPs and within the hospital service for patients with both mental and physical conditions. There was also liaison with Adult Care Services.

1.13 There was discussion on the recent Member visit to Seward Lodge, the in-patient care that was delivered there and the plans to run a day hospital. The emphasis was to keep in-patient stays as brief as possible and for Specialist Mental Health Teams to deliver care in the service user’s own home. GB emphasised the importance of working with voluntary organizations such as Mind and the Alzheimer’s Society.

1.14 In the west of the county there was a pilot of extensive outreach for dementia sufferers, involving intensive short term support in the home aimed at preventing an admission. Day centres would provide brief intervention and respite. Once piloted, if successful, this would be taken out across the county.

1.15 There was a discussion on awareness of how to access services and the benefit of a one-stop-shop for older people. The Specialist Mental Health Team could be accessed at Bull Plain, in Hertford. Contact with them would trigger assessment by the Community Mental Health Team (CMHT) or the Crisis Assessment and Treatment (CAT) team if it was an emergency situation. Members noted that there were seven CMHT across the county and that ACS and GPS all had the central contact number.

1.16 There was discussion on the importance of support being in place

3 following treatment and on service user’s discharge from hospital, or on transfer to continuing care. Funds had been allocated for a placement adviser to work with families; the placement finder would, in particular, assist families to access services that had been repatriated and where there may be concern about distance to travel.

1.17 It was noted that the placement finder would also provide assistance to self-funders and the group acknowledged the importance of self-funders having access to help and support. Members felt that it was important that the service be well publicised and that in-patients and carers were made aware of it.

Repatriation of Adult Mental Health and Substance Misuse Services - Hertsmere

1.18 Members received a presentation from Sally Hickman (SH) project manager for repatriation from Barnet, Enfield and Haringey to Hertsmere, with specific focus on substance misuse services (see Appendix 1). Work was in progress to provide consistent services across the county, although different areas had different levels of need, with some areas having greater drug and alcohol problems than others.

1.19 Crisis Assessment and Treatment (CAT) teams were frequently involved in substance misuse cases and it was still to be resolved where in the county the CAT teams should be located. The plan is to have one central IT system for all the CAT teams to share. SH reported that there were difficulties around recruiting to the crisis teams. SH also reported that there was still tension about traveling times, for example travel times from Potters Bar to Watford where once service users would have gone to Chase Farm.

1.20 Savings achieved by the repatriation were being reinvested in community based services and assertive outreach teams, for example a small assertive outreach team was being developed to serve the Borehamwood area.

1.21 Members commented on age discrimination (generally, not specific to substance abuse) and asked how a service user would make the transition between working age services and older people services. It was noted that both teams work together through a transition protocol and that care needs were dictated individually and not solely on the basis of age.

4 (C) BRIEFING ON CHILDREN’S SERVICES

1.22 Members had visited Forest House in August and congratulated the managers there for the excellent work of the unit. Again, the importance of public awareness of how to access services was stressed, and also that GPs should be kept up-to-date with service changes.

1.23 There was discussion on referral rates to CAMHS Tier 3 which provided a service for the whole of the county. Miriam Mugan advised the group that families with primary school age children who had behavioral problems were advised to access local services such as a parenting group before being referred to CAMHS as often their needs could be met locally without the need for intervention from a specialist CAMH service. Ensuring the appropriateness of referrals had assisted with the reduction of the waiting list.

1.24 Members noted that there were two dedicated adolescent beds in an adult mental health ward in Stevenage for emergency admissions only of young people between the ages of 16-19 years. These beds were under the control of a CAMHS consultant who oversaw any admissions to them. Joint working and training had been developed between CAMHS and the Adult Mental Health staff working on this ward to ensure the needs of the young people were appropriately met. With the planned development of Forest House in 2008 to provide emergency beds the use of adult beds for anyone under the age of 18 years would cease.

1.25 There was discussion on a planning application to extend facilities at Forest House in progress at present and a request from a Member for an update on the status of this. The planning application has been agreed by St Albans District Council.

2. AMBULANCE TRUST

2.1 The group had expected to receive a presentation from Rob Ashford, Locality Chief Operations Officer for Bedfordshire and Hertfordshire East of England Ambulance Service but he was unable to attend.

3. JOINT COMMISSIONING PARTNERSHIP BOARD (JCPB)

3.1 Miriam Mugan, Planning and Commissioning Manager, Child and Adolescent Mental Health, Jess Lievesley, Planning and Commissioning Manager, Mental Health and Steve Malusky, Planning and Commissioning Manager Mental Health for Older People attended the afternoon session

3.2 Members received a presentation on ‘Investing in Your Mental

5 Health Implementation’ from Mark Jordan, Head of Section and the Joint Commissioning Team (see presentation, Appendix 2).

3.3 The Joint Commissioning Team had delegated authority over funding for the HPFT and Learning Disability Services. There was discussion on Practice Based Commissioning, whereby funds are delegated down to GP practices and also on Practice-Based Joint Commissioning. There was discussion on the input from GPs with special interest in mental health and progress with this in areas where this had been piloted (please see the briefing note on PBC and JPBC, Appendix 3, and the summary on Enhanced Primary Care Outcomes, Appendix 4).

3.4 In addition, there was discussion on the following points:

 the need to make decisions and prioritise the service that can be provided from finite resources and the limits to what the JCT can achieve;

 balancing need exceeding resource – particularly social care needs;

 keeping in touch with local needs while working on a county- wide basis and the importance of a flexible approach;

 monitoring of sub-contracted services and continually ensure value for money and efficiency;

 delivery of care that would focus more on recovery and independence with more support from primary care and less from secondary or in-patient care;

 integration of user and carer involvement and ‘third sector” (i.e. voluntary) organisations

 work on making services equitable across the county;

 consideration of full spectrum of needs: housing, relationship, employment;

 Mental Health housing strategy, a key part supporting people with mental health needs;

 recurring theme of public awareness of how to access services across all user age groups.

3.5 Recognition of the role of the carer was stressed. Members commented on the importance of carer support and were informed that Viewpoint had received funding for a user survey. Carers in

6 Herts were also involved with how services were being shaped. The JCPB run public briefing sessions prior to each meeting of the Board (see attached leaflet).

3.6 It was noted that The Supporting People Programme would be subject to a one-off scrutiny by the Adult Care and Community Safety Scrutiny Committee on 11 October and the outcomes of this would be reported back to the topic group.

3.7 Risk awareness was discussed as an area that might be taken forward to the scrutiny committee via the findings and recommendations of this topic group.

3.8 Officers reported on the early indications from specialist GP pilots and outcomes reported by early adopters. The risk of suicide, relapse and readmission to acute services, and admissions via Accident and Emergency departments, would be monitored.

3.9 With regard to financial recovery and the work on the IIYMH strategy, officers advised Members that Foundation Status should offer more stability.

3.10 It was noted that a further area for scrutiny committee to pick up one might be the Joint Practice Based Commissioning and the social care aspect

4. REPORT ON SITE VISITS

4.1 Feedback on visits to Seward Lodge and Forest House has been noted above.

4.2 With regard to the site visit to Albany Lodge the group noted that with working age adults the CMHTs are taking a lower profile, while the CAT teams act as gatekeepers for access to services and as the link from GP to acute services. No problems with capacity had been reported from the unit.

Elaine Gibson Trainee Democratic Services Officer September 2007