Mental Health Implementation Advisory Group Meeting

1st December 2005

Minutes

Present:

IAG: Assembly Officials: Bill Walden-Jones (co-chair) Sarah Austin (minutes) Jeff Williams (co-chair) Phill Chick Mark Boulter Peter Martin Ruth Coombs (o/b Lindsey Foyster) Peter Meredith Smith Joan Doyle Peter Lawler Daphne James Barry Topping Morris Lynette Morgan

Phil Pashley Gillian Thornton Tom Woods Ron Woodall

Apologies: Absent: Paul Clarke Lynn Harris Ian Cutler/Margaret Ellis Karen Hawkins Lindsey Foyster Andy Williams Ian Maunder Michelle Thomas Luisi Suzanne Smith Mark Winston

Item 1. Welcome, Apologies and opening remarks

Jeff Williams welcomed everyone to the meeting and noted the apologies received as above.

Item 2. Matters arising and Action Points from last meeting

Lynette Morgan asked for the minutes of the 29.9.05 meeting to be amended to show that her apologies were received and that she was not absent. Joan Doyle asked for the minutes of the 29.9.05 meeting to be amended to reflect ‘concern that the draft NSF Review document did not make any reference to the Voluntary Sector, unlike the original Framework which specifically mentioned the Voluntary Sector as having a role to play in the implementation of some key actions’.

All Action Points were dealt with.

Item 3. General report on implementation of NSF Standards/ related issues. Sarah Austin submitted a written report in advance of and at the meeting. The report gave updates on the Key Actions that are the responsibility of the Assembly and on some of the areas that are the responsibility of i.e. HCW, LHB’s and LA’s.

Barry Topping Morris provided further background on HCW’s responsibilities regarding the National Learning points arising from the Homicide and Suicide External Reviews. HCW is in the process of engaging with the 4 medium secure units in Wales to implement more robust performance management and quality monitoring measures. This is being done in connection with a strategic review of high secure care to be published in March 2007. Bill Walden-Jones asked how the IAG could contribute to these areas of work. Barry Topping Morris stated that the IAG can offer reflection and review and that the group will be instrumental in providing service user contributions.

Mark Boulter asked what steps are taken to ensure the physical health of mentally disordered detained patients. Barry Topping Morris replied that location of secure units and thus the provision of integrated healthcare is key. He added that performance management systems are only just being designed and implemented in secure units and that there are good initiatives such as at the Caswell Clinic in Bridgend where nurse practitioners are offering clinics that can be flagged up as good practice. There was also discussion around physical healthcare forming part of the performance management arrangements for secure health services. Barry went on to say that HCW and LHB's were to draft and issue joint guidance to encourage mental health services (primary and secondary care) to remain in contact with tertiary secure health care services throughout the patients stay in secure care. The same principle would apply to people known to our mental health services who subsequently spend time in prison. The first draft will be presented to Peter Lawler by the end of January 2006. Phil Chick is leading on this. Barry closed by saying that when LHB’s take on the healthcare commissioning role in prisons from April 2006, that it will mark better and more timely healthcare for prisoners.

Peter Lawler added that LHB’s will be responsible for commissioning healthcare only in public sector prisons. At Parc Prison in Bridgend, the prison operator Securicor is responsible for buying in healthcare. Peter added that there are now mental health prison in reach workers in all Welsh public sector prisons.

Bill Walden-Jones noted concerns around tracking male and female prisoners across the Wales-England border and our responsibility for Welsh prisoners in English prisons.

Ruth Coombs asked if there is likely to be any slippage in delivering any of the Key Actions. Phill Chick confirmed that the mental health promotion and social inclusion work with the cross-Assembly network is underway and will be completed by October 2006 and Sarah Austin confirmed that the mental health race equality action plan will be produced by March 2006, as per the dates given in Raising the Standard. There is no indication of slippage regarding the Key Actions that are the Assembly’s responsibility and Regional Offices have not given any indication of slippage regarding LHB and NHS Trust areas of responsibility. Regarding SaFF targets, reports concerning implementation of the Refocussing and Tidal models are generally positive as is the implementation of Directories, i.e. CALL. It was also noted that there are difficulties in monitoring the NSF overall when only SaFF targets are monitored by the Regional Offices.

Bill Walden-Jones asked for future update reports to be cumulative, reporting on what has happened in the 3 months between meetings. Bill also asked for the advance written report to be a standing item sent together with the agenda.

Action: Sarah Austin to ensure timely submission of Item 3 written report prior to future IAG meetings.

Action: Sarah Austin to ensure that prison healthcare forms a standing item as part of the Item 3 update at future meetings.

Item 4. Good practice sharing There were many examples of good practice shared by group members. These included –

Peter Meredith Smith noted MIND Cymru’s work with the Office of the Chief Nursing Officer regarding the involvement of service users in the training of mental health nurses. Peter also talked about the Mental Health Nursing Awards taking place in February 2006, from which a digest of good practice will be produced and the Welsh Language Nursing Awards where there is a specialist mental health nursing category. Bill Walden-Jones mentioned Hafal’s CPA User Guide which was launched on World Mental Health Day. 10,000 copies have been produced. Phill Chick talked about Conwy and Denbighshire’s primary care in-reach service which has resulted in positive outcomes for service users. Phill also mentioned a Rhondda Cynon Taff initiative ‘The Only Way Is Up’ which is a proforma developed by service users designed to help them prepare for CPA meetings, act as an aide memoire and empower their voice. Bill suggested that ‘The Only Way Is Up’ proforma could be used in conjunction with Hafal’s CPA User Guide. Phill also mentioned the Bibliotherapy roll-out. It has proved a very popular initiative across Wales with interest from the Sunday Telegraph and the Department of Health. The Bibliotherapy initiative is seen as a model of social prescribing. Finally, Phill mentioned a successful mental and sexual health scheme (MASH) which is seen as a good collaboration between primary and secondary healthcare. Mark Boulter mentioned the Primary Care Network Nursing Awards. Bill Walden-Jones concluded that there was clearly a great deal of work going on across Wales and that sharing good practice among the group was a useful exercise. Bill asked for good practice to be kept as a standing agenda item. Joan Doyle suggested that a good practice website could be set up.

Action: Sarah Austin to ensure good practice sharing is kept as a standing agenda item for future IAG meetings. Action: Sarah Austin to investigate developing a good practice website and to report back at the next meeting.

Item 5. Regional Commissioning Peter Lawler stated that work on regional commissioning is being led by Geraint Martin at the Assembly, as per the commitment given in Designed for Life. Peter added that mental health will be part of this but that we need to know the ‘bigger picture’ first. Peter concluded that the option appraisal as mentioned in Raising the Standard will commence in early 2006.

Bill Walden-Jones stated that members of the Wales Alliance for Mental Health are close to agreeing a point of view on regional commissioning – that there should not be more than 3 commissioning bodies for mental health and that this point is intended as a marker to contribute to the wider discussion around this issue. Peter Lawler asked if WAMH’s view would be conveyed to the Assembly: Bill replied that it would be in the form of a letter to the Minister and that the Alliance would be happy to participate in any Assembly led exercise.

Mark Boulter mentioned GP practice based commissioning being seriously considered in England and asked if this is being considered in Wales. Peter Lawler replied that this is unheard of in Wales and would not be supported by the Assembly.

Bill Walden-Jones is shortly to visit Ireland to discuss centralised mental health commissioning.

Barry Topping Morris noted that there appears not to be a firm definition of what commissioning actually is and that Designed for Life is not prescriptive in defining commissioning. Phill Chick added that it involves contracting, planning, monitoring and review. Peter Meredith Smith questioned whether a ‘one size fits all’ approach to commissioning is appropriate. Bill Walden-Jones noted the distinctive arrangements between health, social care and criminal justice and due regard would have to be given to these relationships in the commissioning process.

Mark Boulter added that the focus on mental health in local Health Social Care and Wellbeing Strategies needs to be robust.

Phill Chick stated that he felt that some mental health services are better suited than others to being commissioned on a regional basis and that local commissioning arrangements are more appropriate for some services, i.e. regarding mental health promotion - local action at the local level.

Peter Lawler concluded by saying that any decisions on commissioning arrangements will be made by 1st April 2007.

Action: Bill Walden-Jones and Jeff Williams to decide if Commissioning will be a Workshop subject at the next IAG meeting.

Item 6. Workforce issues – draft Policy Implementation Guidance. Peter Meredith Smith summarised the progress update papers sent to IAG members in advance of the meeting and explained the areas of work for members to discuss and advise on in the afternoon Workshops. Peter tabled at the meeting the draft P.I.G. titled ‘Changing for the Best – Mental Health Workforce Modernisation in Wales’. Attached to these minutes are copies of the papers giving further details of the Workforce issues.

Item 7. Raising the Standard - update and discussion. There was general discussion around CMHT’s. Phill Chick stated that generic teams haven’t worked and need to be replaced with multi-functional teams containing specialist workers, i.e. eating disorders specialists. Gillian Thornton added that she only sees resources being taken away from the teams and Mark Boulter noted that team staff could title themselves ‘specialist generalists’.

Item 8. Update on SaFF Targets. Peter Lawler stated that the 2006-07 targets will be issued around Christmas but that they won’t be signed off by the Minister. They are likely to be issued via a Welsh Health Circular. The areas are – mental health and primary care: gateway workers and structured counselling and access to psychological therapies for people on CPA.

Action: Sarah Austin to circulate the Welsh Health Circular or equivalent to IAG members as soon as it’s available (not a web link).

Workshop Notes attached at Annex 1

Dates of Next Meetings

23rd March 2006 15th June 2006 28th September 2006 6th December 2006

Venues to be confirmed and advised. Annex 1

Workshop Notes - Workforce Issues

1. Do we agree that the document should be short and sharp?

Group 1 Not as short as the document tabled - needs more detail but needs to remain succinct in order to sustain impact – needs to engage as many people as possible and not put people off - is it general guidance or specific/directive?

Group 2 Yes!

2. Are the issues emerging for inclusion (as per the draft) appropriate and in line with IAG discussions thus far?

Group 1 Needs to have end goals.

3. What other issues need to be considered?

Group 1 Need to engage social care and education – a wider model of mental health care which will mean a wider workforce - need to engage a wide range of non mental health agencies – needs to address safety issues and allow risk taking – needs to be rural-proofed (as with race proofing) – needs to carefully involve service users. 4. How prescriptive do we need to be regarding our implementation advice?

Group 1 Prescriptive re: quotas for workforce type or make needs-led or be permissive i.e. use non-professionals if needed or change planning – need to factor in the realistic availability of professionals.

Group 2 Central focus on core competencies (kite marking) – gathering of statistics – could tie in the following: Picasso (Psychological Interventions for Coping with Anger and Schizophrenia)/Certificate in Mental Health/NVQs and other FE college qualifications and training/HPW work/Knowledge and Skills Framework/Agenda for Change/Skills for Health/training for trainers/Expert Patients Programme/NLIAH/CPD/ASW training Schools of Medicine, Psychology etc – health and social care workforce interface

5. What are the key issues on which workforce modernisation stakeholders require the most specific guidance?

Group 1 User-led – self-help – risk taking – diverse skills – experience of the system (good and bad) – creativity – take account of private sector workforce needs.

Group 2 Common training across boundaries – information sharing – voluntary sector need to get up to speed – common minimum standards – pathways from voluntary sector to statutory sector – career pathways for non statutory workers – shared learning.

6. How can we ensure that workforce planning is holistic and meaningfully brings together: health, social, non-statutory and voluntary services?

Group 1 Did not complete this question.

Group 2 Integrated mapping of current staffing including LAs, NHS organisations and NGO’s – retaining at the core the multi agency, multi professional nature of CMHTs – must have core competences – reducing boundaries between statutory and non statutory/primary tier 1 and secondary tier 2-3 services – capacity in voluntary sector to organise and focus on workforce redevelopment and training.

7. Are there any other issues that the group wishes to feed back?

Group 1 Cultural diversity – training and background relevance – explain what is a non professional role – equalities and language issues.

Group 2 Risk – asset stripping of voluntary sector staff – funding – job security – governance – competing terms and conditions – need to create a level playing field – skills thresholds.

The following is an amalgamation of notes from Group 2 relating to questions 4, 3 and 2 -

Health and social care workforce interface – fundamental debate on the future of social care in health – retaining the value and skill base of multi professional inputs – core competencies related to core functions – guidance needs to be permissive – are we producing staff with the right skills? – graduate and postgraduate training – guidance needs to be inclusive – feed from professional groups into workforce planning – workforce plan as part of local strategic plan and regional planning – integrated service and workforce planning, e.g. a 2 year plan to develop supported accommodation – plan workforce based on competency.