Format for Progress Report

MENTAL HEALTH AND WELL BEING SUPPORT GROUP

REPORT OF VISIT TO LOTHIAN – 22 MAY 2001

Report of Visit to Lothian – 22 May 2001 (Pages 1 to 4)

The 6 Month Progress Report - December 2001 (Pages 5 to 24) MENTAL HEALTH AND WELL BEING SUPPORT GROUP REPORT OF VISIT TO LOTHIAN – 22 MAY 2001

On this occasion, the Support Group was represented by:

• Ms Morag Brown (Principal Officer, Older People and Dementia, City of Glasgow Social Work Department) • Mrs Sheila Cooper (Carer Representative, NSF) • Mr Brendan Gill (Director of Planning and Information, Lanarkshire Health Board) • Mrs Elisabeth Hill, OBE (Tayside Alcohol & Drug Alliance) • Mr David Pia (Assistant Chief Inspector, Social Work Services Inspectorate) • Mr Simon Porter (User Representative, Glasgow Association of Mental Health) • Dr Ian Pullen, Chairman (Consultant Psychiatrist, Borders Primary Care NHS Trust) • Mr Robert Samuel (Nursing Adviser, Scottish Executive)

Summary

The Support Group was impressed by the enthusiasm shown and range of interests present on the day. Much progress has been achieved in reshaping mental health services during this past 3 years and the complexity of this change process is acknowledged. The resource constraints locally within mental health and lack of a local comprehensive needs assessment are major impediments to making further rapid progress in implementing the Mental Health Framework in this priority area.

Findings

There was much for the Support Group to commend, including:

• Carers and users of services were very positive about many of the services which individual clients/patients received.

• LHCCs in many parts of Lothian have positively embraced the running and management of mental health services.

• In West Lothian the major resettlement programme and reconfiguration of services leading to the imminent closure of Bangour Village Hospital. It is recognised that this was achieved with only limited availability of bridging resources.

• The complexity of the change process within the Lothian Health Board area and associated local authorities is acknowledged. Nevertheless, good progress has been made in many areas.

• The development of new services, particularly the new Young Peoples Unit and Local Forensic Unit at the Royal Edinburgh Hospital are significant achievements.

The Support Group had concerns about issues in the following areas and while not attaching individual timetables for action in each case, it will look to see early attention being given and recorded in the response to its request for a 6 month progress report.

Resources

1 • Lothian Health Board’s spend per head of population on Mental Health Services is lower than the Scottish average. This should however be set against the Board’s non- gaining situation post Arbuthnott and the commissioning of the new Royal Infirmary.

• The partner agencies should review the current Mental Health Joint Implementation Strategy and identify the priorities to be achieved with the resources available within the Framework for Mental Health implementation timetable (2004).

Planning

• It is important that all partner agencies sign up to the Joint Planning Arrangements. The planning partners should consider how local plans and the overall strategy come together so that the priorities to be achieved in moving the mental health agenda forward over the next 3 years can be addressed on an equitable basis.

• A timetabled, costed plan showing what is needed and where, provided by which agency is needed.

Care Programme Approach (CPA)

• The Group heard concerns about the lack of implementation of CPA within the City of Edinburgh. The agencies should implement the CPA without delay and apply the arrangements to regular audit. That audit process should provide a very useful mechanism for identifying service deficits and inform how services should be reshaped to respond to such need. Ref SWSG 16/96 and Our National Health, Section 7.

Needs Assessment

• It is recognised that agencies across the Lothians have undertaken various pieces of needs assessment work. However a comprehensive needs assessment is now required to inform planning and other joint agency decisions. The Support Group guidance Needs assessment for a Comprehensive Local Mental Health Service is commended in this regard.

• It will be important to adopt an inclusive process to ensure user/carers and partner agencies are able to contribute meaningfully to such a process.

User and Carer Involvement

• The Group heard throughout the day the various arrangements within each local area for engaging user and carer involvement in the planning processes and major changes.

• The partner agencies should ensure that the processes in place enable users and carers to be actively and meaningfully involved in helping to shape service delivery and such involvement occurs at the right time.

Advocacy

• The pattern of advocacy is variable across Lothian. Some concerns were expressed about access to collective and independent advocacy by users of services. We look

2 forward to an update on progress made towards the further development of advocacy services across Lothian prior to our next visit.

Psychological Therapies

• Our attention was drawn to the waiting times in accessing psychological therapies. There are clearly different models and ways in which services can respond to meet such need and to make an improvement on the current position. There is a need to take a strategic view as to how these services should be structured and organised in order to make more effective use of the current limited resources available. The planned visit from the Support Group sub Group on this matter was discussed.

The Support Group looks for the issues identified and raised here to be addressed in the ongoing and future planned activity of all the agencies involved. As earlier indicated, the Support Group will request a written update on the progress made against the comments offered in this document in around 6 months. That update will be published on the web site alongside this report.

Finally, the Support Group would like to thank all who attended and participated on the day and those whose contributions to the arrangements made the day and visit run smoothly.

Mental Health and Well Being Support Group 19 June 2001

3 Appendix

Background and Purpose of the Support Group

The Support Group was formed on 31 March 2000 to support, influence and advance the further strategic development of mental health services in Scotland. The Support Group offers advice locally and to the Scottish Executive on solutions and best practice in advancing the implementation programme of the Framework for Mental Health Services in Scotland agenda for change and improvement in mental health services. The Group also provides additional focused local activity assessments to the Scottish Executive and the agencies involved. The Support Group complements, but does not replace related activity of the Joint Future Group, the mentor and advice remits of the Scottish Health Advisory Services, the Mental Welfare Commission or the Clinical Standards Board for Scotland.

Approach/Process

The Support Group issues a template, for completion by the partner agencies prior to visits. The template is based on Scottish Executive guidance material, and other relevant material including:

• A Framework for Mental Services in Scotland (1997) • Advocacy – A Guide to Good Practice (1997) • Mental Health Promotion in Scotland – Board Position paper HEBS (1998) • Services for Women in Postnatal Depression NHS MEL(1999)27 • Priorities and Planning Guidance 1999-2000 for the NHS in Scotland (1998) • Implementing the Care Programme Approach (SWSG/Accounts Commission Survey) (1998) • A Shared Approach (Accounts Commission) (1999) • Our National Health: a plan for action, a plan for change • Risk Management (2000) • Needs Assessment for a Comprehensive, Local Mental Health Service (2001) • Annual Report – Mental Health and Well Being Support Group (2001)

During the visit individual members of the Support Group meet with groups of individuals, including users and carers, representing the range of stakeholder interests in the development and implementation of the joint mental health strategies in the area visited. Meetings also take place with the joint planning and implementation team and the key agency Executives.

The Support Group is grateful for the co-operation and assistance of the statutory and non- statutory agencies in the area.

Further information about the Support Group, including its Annual Report, can be found on its web site at http://www.show.scot.nhs.uk/mhwbsg.

4 MENTAL HEALTH AND WELL BEING SUPPORT GROUP SIX MONTH PROGRESS REPORT DECEMBER 2001

VISIT REPORT PROGRESS REPORT AREAS FOR ATTENTION / ACTION ACTION INITIATED / REQUIRED LEAD GROUP / TIMESCALE INDIVIDUAL Resources • We have undertaken the attached analysis which shows that in terms of % of total funds available Lothian is not below Lothian Health Board’s spend per head of the average. population on Mental Health Services is lower than the Scottish average. This should • It is widely recognised how imprecise these national however be set against the Board’s non- comparisons are as no two Boards include the same services gaining situation post Arbuthnott and the or costs in their figures. commissioning of the new Royal Infirmary. • A further complication is the transfer of resources to the LAs, making comparisons between NHS Boards alone inappropriate.

• We will continue to keep our spending under review in Lothian NHS Board Ongoing and reviewed comparison with others but we will give greater weight to Finance and Social Inclusion each year. year on year comparisons of what Health & the LAs jointly and Community Care spend on MH. This is the figure we aim to increase in real terms yr. on yr. ------The partner agencies should review the current Mental Health Joint Implementation • We are undertaking a substantial review of MH priorities Lothian NHS Board Ongoing Strategy and identify the priorities to be extending beyond the needs covered by the MH Framework.. SICC and Public Health with achieved with the resources available within planning partners. the Framework for Mental Health • Mental Health priorities will be incorporated into Lothian’s

5 implementation timetable (2004). local health plan. Lothian NHS Strategic First local health plan Planning Group with planning Christmas 2001 partners. AREAS FOR ATTENTION / ACTION ACTION INITIATED / REQUIRED LEAD GROUP / TIMESCALE INDIVIDUAL Planning • Lothian Health, Trusts and Council colleagues are signed up It is important that all partner agencies sign to their local plans. In Edinburgh they also have a Jointly up to the Joint Planning Arrangements. The Funded post to progress planning and implementation Lothian NHS Board & Local Early elements for planning partners should consider how local arrangements between LPCT and CECSWD. We will be Authorities via the community mental health by plans and the overall strategy come together moving forward over the next 6 months to begin care joint agency planning Summer 2002. so that the priorities to be achieved in implementing the Joint Future Report as it applies to MH. groups across Lothian. moving the mental health agenda forward over the next 3 years can be addressed on an • In reviewing and implementing joint mental health plans we Lothian NHS Board Over 3 years in equitable basis. shall be redistributing resources from West Lothian to less accordance with well resourced areas elsewhere in the Lothians and Mental Health completing a shift from hospital to community services, Strategy. including community based developments in East and Midlothian, and undertaking a major redevelopment of the Royal Edinburgh Hospital.

• We are enclosing the updated financial plans which were sent Lothian NHS Board A timetabled, costed plan showing what is to the MHWB Support Group before their visit as these Finance and SICC needed and where, provided by which constitute the costed plans we use. They are regularly agency is needed. updated.

6 AREAS FOR ATTENTION / ACTION ACTION INITIATED / REQUIRED LEAD GROUP / TIMESCALE INDIVIDUAL Care Programme Approach (CPA) Edinburgh • LPCT and CEC SWD are currently reviewing the LPCT and CEC SWD The Group heard concerns about the lack arrangements for CPA within Edinburgh of implementation of CPA within the City of Edinburgh. The agencies should • A revised implementation plan is being developed with clear CPA Edinburgh Management implement the CPA without delay and systems for regular audit. There are over 50 people on CPA in Group. apply the arrangements to regular audit. Edinburgh. Audit information will be used to identify service That audit process should provide a very deficits and unmet need. useful mechanism for identifying service deficits and inform how services should be Midlothian reshaped to respond to such need. Ref • CPA audited through Joint Management Group, chaired by SWSG 16/96 and Our National Health, MHCC has reps from social work, housing, nursing, Midlothian Health Care Co-op, Section 7. psychiatry, police, vol sector and service user orgs.

West Lothian • Audit arrangements part of agreed CPA protocol and managed West Lothian Joint Steering by Joint Steering Group. Group.

East Lothian • CPA management group recently reconstituted with a new East Lothian CPA Management monitoring process in place. Group.

7 AREAS FOR ATTENTION / ACTION ACTION INITIATED / REQUIRED LEAD GROUP / TIMESCALE INDIVIDUAL Needs Assessment

It is recognised that agencies across the • Lothian Health PH Directorate presently working on a needs Lothian NHS Board Summer 2002 Lothians have undertaken various pieces of assessment of mental health services, which will be progressed Public Health Directorate. needs assessment work. However a and developed with input from agencies across Lothian – comprehensive needs assessment is now LHCCs, Social Work, vol sector, users and carers required to inform planning and other joint agency decisions. The Support Group • The needs assessment will be comprehensive, including guidance Needs assessment for a everyone's needs at a demographic level taking into account Comprehensive Local Mental Health deprivation etc. Service is commended in this regard. • Needs will also be assessed locally through LHCCs and local Ongoing as part of Community It will be important to adopt an inclusive carers and users groups, including people who might Care joint agency planning process to ensure user/carers and partner otherwise be excluded. Work recently completed in groups and local health care co- agencies are able to contribute Midlothian is a good example of this. op developments. meaningfully to such a process.

• Midlothian currently have a multi agency group looking at Midlothian LHCC gaps in services for people who misuse alcohol.

8 AREAS FOR ATTENTION / ACTION ACTION INITIATED / REQUIRED LEAD GROUP / TIMESCALE INDIVIDUAL User and Carer Involvement

The Group heard throughout the day the • Aim to ensure that user and carer reps are included within the The Statutory Authorities End 2003 various arrangements within each local majority of community care planning groups and task groups. area for engaging user and carer involvement in the planning processes and • Identified a need to explore other meaningful ways of major changes. involving users and carers, such as drawing on some of the lessons of the needs assessment exercise in Midlothian. The partner agencies should ensure that the LHCCs now working with Patient Involvement Workers. processes in place enable users and carers to be actively and meaningfully involved • Continue to support organisations such as Edinburgh Carers The Statutory Authorities Ongoing in helping to shape service delivery and Council and support their Carers Code of Practice for those such involvement occurs at the right time. who care for family / friends with mental health problems. The Code has been endorsed by CEC, LPCT and LHB.

• Users and Carers are involved in drawing up and presenting plans and proposals to the Chief Officer Groups in each LA Local Authorities Annual planning cycle when they are ready for consideration.

• Support and liase with service user and carer mental health Local Authorities and Local Ongoing forums. Healthcare Co-ops.

• Mental Health Forum in West Lothian is established part of Health Wellbeing Mental Ongoing community planning structure. Health Community Care Planning Group

9 AREAS FOR ATTENTION / ACTION ACTION INITIATED / REQUIRED LEAD GROUP / TIMESCALE INDIVIDUAL Advocacy • Lothian Advocacy Planning Group Interim Action Plan Lothian wide multi agency To be agreed 2002. The pattern of advocacy is variable across covering all Lothian. Lothian NHS Unified Board is preparing group. Lothian. Some concerns were expressed an Advocacy Strategy covering all client groups. about access to collective and independent advocacy by users of services. We look • West Lothian – Agreed to maintain funding levels and review forward to an update on progress made service 2002/03 towards the further development of advocacy services across Lothian prior to • Edin - A report on the strategic development of Mental Health Edinburgh Strategic Ongoing as funding is our next visit. Advocacy in Edinburgh has just been completed which has a Development Group for Mental identified. key aim of improving access to advocacy within the City. It Health. includes a recommendation to invest a further £50,000 in MH Advocacy. Spend on independent advocacy services for users is currently £350,000 in Edinburgh and includes collective and individual services.

• Midlothian – following their local needs assessment have identified investment in independent advocacy as an early Midlothian Chief Officers 2002/03 – 2003/04 priority when funding becomes available. Group and Lothian NHS Board.

10 AREAS FOR ATTENTION / ACTION ACTION INITIATED / REQUIRED LEAD GROUP / TIMESCALE INDIVIDUAL Psychological Therapies • Recognise long waiting times due to high demand for a very Addressed within mental health By 2004 Our attention was drawn to the waiting limited staffed service – particular recruitment problems. priorities and mental health times in accessing psychological therapies. strategy. There are clearly different models and • Note that some LHCCs provide part time sessions of ways in which services can respond to psychological therapy and / or use counsellors in practices. meet such need and to make an improvement on the current position. • Midlothian – appointment of Nurse Consultant with a special Midlothian LHCC Actioned 2001 There is a need to take a strategic view as remit for people with enduring mental illness and the to how these services should be structured development of psychosocial interventions. and organised in order to make more effective use of the current limited • Developing innovative ways of meeting the need for resources available. The planned visit psychological therapy through training staff in CBT, Family Lothian Primary Care Trust. Ongoing. from the Support Group sub Group on this Therapy, etc. matter was discussed. • West Lothian LHCC Task Group is redesigning services for West Lothian Primary Care June 2002 people with anxiety and depression. Directorate

11 SCOTTISH HEALTH BOARDS - MENTAL HEALTH EXPENDITURE Comparison 1999/2000 Outturn 2000/01 Forecast 2000/01 Qtr 3 Cum Outturn 1999 Population (£000's) % Tot (£/head of (£000's) % Tot (£/head of (£000's) % Tot (£/head of Pop) HCH Pop) HCH Pop) HCH Scotland 435,184 13 85 460,836 13 90 342,932 13 67 Scotland 5,119,200 Western Isles 3,088 12 112 3,422 13 124 2,580 13 94 Western Isles 27,560 Tayside 43,748 17 113 45,425 17 117 34,072 17 88 Tayside 388,300 Argyll & Clyde 42,319 15 99 45,069 15 106 33,801 15 79 Argyll & Clyde 425,600 Borders 10,431 14 98 11,018 14 104 8,263 14 78 Borders 106,400 Greater Glasgow 84,027 14 93 87,636 14 97 65,943 14 73 Greater Glasgow 906,000 Dumfries & Galloway 12,931 13 88 14,020 13 96 9,562 12 65 Dumfries & Galloway 146,800 Ayrshire & Arran 31,319 14 84 35,185 15 94 26,389 15 70 Ayrshire & Arran 374,600 Lothian 61,220 14 79 64,490 14 83 48,368 12 62 Lothian 778,500 Grampian 42,328 14 81 43,224 14 82 32,162 14 61 Grampian 525,300 Lanarkshire 41,597 12 74 45,095 13 80 32,125 12 57 Lanarkshire 562,400 Highland 14,679 11 70 16,103 12 77 12,077 12 58 Highland 208,600 Fife 26,036 13 75 26,910 13 77 20,183 13 58 Fife 349,200 Forth Valley 20,309 12 73 21,269 12 77 15,945 12 57 Forth Valley 277,600 Shetland 399 2 18 1,320 8 58 991 8 44 Shetland 22,740 Orkney 753 5 38 651 4 33 471 4 24 Orkney 19,600

ISD Data 2000/01 Apr-Dec

MENTAL HEALTH (Comprises specialties mental illness, psychogeriatrics, child psychiatry, adolescent psychiatry reported on SMR4 returns) Includes: Occupied bed days from the specialties mental illness, child and adolescent psychiatry. Occupied bed days from the specialty psychogeriatrics. New out-patient attendances in all the above specified specialties. This covers all new out-patient attendances - as reported on SMR00. Attendances by mental health day patients. Excludes: Resource Transfer - this would include community services (home care/day care/domiciliary etc) and supported RH/NH places. Elements within the community provided by NHS Trusts?

12 MENTAL HEALTH AND WELL BEING SUPPORT GROUP SIX MONTH PROGRESS REPORT DECEMBER 2001 – LOTHIAN FINAL 19/12/01 West Lothian: Mental Health Strategy Designated Mental Health services purchased by Lothian Health & West Lothian Council Mental health Services Existing Base 00/01 Changes NHS Reprovision Net Change Forecast Base Occupied Beds/Places (Net Release) NHS RT SWD Total 00/01 01/02 02/03 03/04 NHS RT SWD Total NHS RT SWD Total Existing Forecast Bangour Village Hospital IPCU (623) 13 (13) Resettlement inpatients 1,090 1090 (881) (1,090) (1,090) (1,090) 70 (70) Continuing Care Inpatients 496 496 (459) (496) (496) (496) 33 (33) Day Activities 121 121 (121) (121) (121) Day Hospital 128 128 (128) (128) (128) Unreleasable Costs 679 679 360 (478) (478) (478) 201 201 St Johns Hospital Acute Psychiatric Care Inpatients 1,903 1903 1903 1903 Day Patients 377 377 377 377 Outpatients 355 355 355 355 IPCU 635 635 476 635 635 12 12 Unreleasable Costs Transfer 130 130 98 130 130 ICCU 512 512 384 512 512 20 20 Unreleasable Cost Transfer 105 105 79 105 105 Anti-Psychotic Drugs 40 40 40 40 Clinical Psychology – TBC 317 317 317 317 Whitburn House Rehabilitation Psychiatry Inpatients 434 434 434 434 Willow Grove (Young People) Existing Services 403 403 403 403 Service Provision across Lothian Community Services Costs Transfer from BVH (Physio, OT etc) 255 255 255 255 255 Outpatients 366 366 366 366 *Community Joint Mental Health Services *Other Community Psychiatry Staff 373 373 51 103 53 104 52 122 278 477 52 122 651 *MH Domiciliary Support/Outreach Team 86 86 (86) (86) (0) (0)

13 MENTAL HEALTH AND WELL BEING SUPPORT GROUP SIX MONTH PROGRESS REPORT DECEMBER 2001 – LOTHIAN FINAL 19/12/01

Existing Base 00/01 Change NHS Reprovision Net Change Forecast Base Occupied Beds/Places s (Net Release NHS RT SWD Total 00/01 01/02 02/03 03/04 NHS RT SWD Total NHS RT SWD Total Existing Forecast Community Services cont’d Day Services *Bathgate 95 114 209 95 114 209 *Broxburn 168 168 168 168 168 *Livingston 46 46 137 137 137 182 182 Hosptial Based Day Services (incl. in St John’s) Accommodation and Support – General * Supported Accommodation 472 72 543 199 598 598 598 1070 72 1141 * Nursing / Residential Care Homes 37 211 249 37 112 112 112 149 211 361 77 77 * General Domiciliary Support 39 39 60 60 60 60 39 99 Respite 4 4 5 5 5 5 4 9 * Care Management 64 64 64 64 * MHO, Other Social Work Staff 237 237 237 237 * Training and work-based initiatives (0) 22 22 (0) 146 146 146 (0) 168 168 Advocacy 34 34 16 16 16 50 50 Other Community Services elsewhere in WL 23 23 23 23 23 Other Community Services (WLC funded) 47 47 47 47 WL Council other Budget expenditure 100 100 (100) (100) Primary Care Related 95 95 51 51 51 146 146 Lothian-wide services: WL Share Specialist Services Brain Injury 50 21 71 50 21 71 Other (Eating Disorders / Psychology / 115 115 115 115 Psychotherapy / Psychosexual) Health Promotion Other NHS MHS elsewhere in Lothian # 246 246 (21) 1050 (94) 956 956 1202 1202 Short Term Costs Patient Advocacy 31 31 (31) (31) (31) Change Management 23 23 (23) (23) (23) Care Management 9407 576 930 10868 0 (0) 62 (1071) 1133 62 8336 1710 930 10976 (a)

14 MENTAL HEALTH AND WELL BEING SUPPORT GROUP SIX MONTH PROGRESS REPORT DECEMBER 2001 – LOTHIAN FINAL 19/12/01

Note * costs of future services to be identified. Livingston & Broxburn Day Services Gross costs shown - Potential M.I.S.G income 70% of costs to be applied for training & Work Based initiatives. # source of temporary bridging finance. (a) Possible source of funding to be M.I.S.G (Mental Illness Specific Grant) or Temporary Bridging for NHS services elsewhere in Lothian.

Notes: 1. Includes NHS staff input to Bathgate House, Deans Club, etc. 2. MISG Funded - 30% WLC, 70% SO. 3. Resource Transfer

Penumbra 8 SAMH (Applecairn/Newell) 94 SAMH Bathgate Training Centre 22 Edinvar 102 SAMH Applecairn - addn'l 97/98 25 Edinvar - Addn'l 97/98 43 294

15 MENTAL HEALTH AND WELL BEING SUPPORT GROUP SIX MONTH PROGRESS REPORT DECEMBER 2001 – LOTHIAN FINAL 19/12/01

EAST LOTHIAN : MENTAL HEALTH STRATEGY Designated Mental Health Services purchased by Lothian Health & East Lothian Council

Mental Health Services Existing Base 00/01 Changes Net Change Forecast Base Existing Forecast

NHS RT ELC Total 2000/01 2001 2002 2003 NHS RT ELC Total NHS RT ELC Total Base Changes Base /02 /03 /04 HOSPITAL SERVICES Herdmanflat

Acute General Psychiatry Inpatients 905 (905) (905) (905) 24 24

Rehabilitation Inpatients 44

Resettlement Inpatients 5(5)

Continuing Care Inpatients 5(5)

Respite Inpatient 1(1) COMMUNITY SERVICES Community Services (NHS Purchased) Edenhall Clinical Psychiatry Outpatients 21 21 21 General Acute Day patients 242 242 242 242 General Acute Outpatients 64 64 64 64 Anti-Psychotic Drugs 40 40 40 40 Roodlands Clinical Psychology Outpatients 4 44 General Acute Outpatients 14 14 14 14 Herdmanflat Clinical Psychology Outpatients General Acute Day patients 215 215 (215) (215) (215) General Acute Outpatients HERDMANFLAT REPROVISION (Under Consideration) 1,120 1,120 1,120 1,120 1,120 Other Community Services Community Psychiatric Nurses 334 334 334 Community Staff Teams 240 240 240 240

16 MENTAL HEALTH AND WELL BEING SUPPORT GROUP SIX MONTH PROGRESS REPORT DECEMBER 2001 – LOTHIAN FINAL 19/12/01

Mental Health Services Existing Base 00/01 Changes Net Change Forecast Base Existing Forecast

NHS RT ELC Total 2000/01 2001 2002 2003 NHS RT ELC Total NHS RT ELC Total Base Changes Base /02 /03 /04 Primary Care related 15 15 15 15 15 Community Services (LA Purchased) Community Support Voluntary Organisations (RT) 145 145 Home Care Services 23 23 0 0 23 23 Mental Health Officer 126 126 3 3 129 129 Residential & Nursing Homes Places 90 90 Emloyment 15 15 (3) (3) 12 12 Voluntary Organisations (Transport & Grants) 33 33 M.I.S.G Various Projects 287 287 4 4 291 291 EL Council Other budget Expenditure (8)(8) (6)(6) Community Services (NHS/LA Purchased) Community Supported Accommodation 90 90 90 90 90 Other Community Based Projects(Day Activities) 85 35 30 90 120 30 90 120 SPECIALST SERVICES - ** Edinburgh Sick Children Special Services Young People 196 196 196 196 Royal Edinburgh Hospital IPCU 65 65 65 65 Forensic 288 288 288 288 Alcohol (Inpatients/Daypatient/Outpatient) 100 100 100 Brain Injury Inpatients } 29 29 29 29 Other(Eating Disorders/Psychology/Psychotherapy/Psychosexual) 67 67 67 Young People Services (Inp/Op) 158 158 158 Royal Infirmary of Edinburgh Liaison Psychiatry 36 36 36 36

17 MENTAL HEALTH AND WELL BEING SUPPORT GROUP SIX MONTH PROGRESS REPORT DECEMBER 2001 – LOTHIAN FINAL 19/12/01

Mental Health Services Existing Base 00/01 Changes Net Change Forecast Base Existing Forecast

NHS RT EL Total 2000/01 2001 2002 2003 NHS RT ELC Total NHS RT ELC Total Base Changes Base C /02 /03 /04 Western General Hospital Liaison Psychiatry T.B.A Other Special Services OTHER

3,019 145 54 3,706 175 50 45 180 225 3,064 325 543 3,931 39 (11) 28 3

Footnotes:

** Denotes specialist and other services for a population wider than Edinburgh. Notional Expenditure Shown Based on Population. 1All changes shown are in accordance with the Joint NHS and Local Authority strategies on Mental Health Services. 2All changes shown are in accordance with the Community Care Plans and Joint Strategies for Mental Health Services. 3Community Supported Accommodation costs are shown net of any DSS income. 4Reprovision for Herdmanflat Acute General Psychiatry Inpatient to be within the existing fianacial envelope and is planned for 2000/01.

Voluntary Organisations SAMH Lammermuir 15952 15952 Penumbra 122640 122640 Inflation 98/99 3118 3118 Inflation 99/00 2958 2958 144668 144668

18 MENTAL HEALTH AND WELL BEING SUPPORT GROUP SIX MONTH PROGRESS REPORT DECEMBER 2001 – LOTHIAN FINAL 19/12/01

MIDLOTHIAN : MENTAL HEALTH STRATEGY Designated Mental Health Services purchased by Lothian Health & Midlothian Council Occupied Beds/Places

Mental Health Services Existing Base 00/01 Changes Proposed Reprovision/ Net Change Forecast Base Existing Forecast (Net Release) NHS RT MLC Total 2000/01 2001 2002 2003/04 NHS RT MLC Total NHS RT MLC Total Base Changes Base /02 /03 HOSPITAL SERVICES Rosslynlee

Acute General Psychiatry Inpatients 744 (744) (744) (744) 19 (19)

Rehabilitation Inpatients 616 616 (616) (616) (616) 14 (14) Anti-Psychotic Drugs 40 40 40 40 Midlothian Community Hospital

Acute General Psychiatry Inpatients 802 802 802 802 802 15 15

Rehabilitation Inpatients 342 342 342 342 342 66 COMMUNITY SERVICES Community Services (NHS Purchased) Community Staff Teams - East 250 250 250 Community Staff Teams - West 250 250 250 Community Staff Teams - Rehab 200 200 200 Crisis Team 140 140 140 140 Primary Care Services Counsellors Other 50 50 50 50 50 Community Services (LA Purchased) Community Support Residential 95 95 95 95 Nursing Home 51 51 51 51 Day Care 5 157 163 5 157 163 Home Care 18 330 348 18 330 348 Respite 7 7 21 21 21 21 7 28 Other 199 199 199 199 19 MENTAL HEALTH AND WELL BEING SUPPORT GROUP SIX MONTH PROGRESS REPORT DECEMBER 2001 – LOTHIAN FINAL 19/12/01

Occupied Beds/Places

Community Supported Accommodation 125 125 125 125 125 99

Rehab - Residential (see note) 127 64 64 127 64 64 127 66 Supported Employment/Day Oppurtunity 50 13 38 50 13 43 29 84 Social Crisis/Self Harm/Alcohol 50 25 19 56 75 19 56 75 Other Community Based Projects 25 25 13 38 50 13 38 50 SPECIALST SERVICES - ** Edinburgh Sick Children Special Services Young People 177 177 177 177 Royal Edinburgh Hospital IPCU 58 58 58 58 Forensic 260 260 260 260 Alcohol (Inpatients/Daypatient/Outpatient) 90 90 90 Brain Injury Inpatients } 26 26 26 26 Other(Eating Disorders/Psychology/Psychotherapy/Psychosexual) 61 61 61 Young People Services (Inp/Op) 143 143 143 Royal Infirmary of Edinburgh Liaison Psychiatry 33 33 33 33 Western General Hospital Liaison Psychiatry T.B.A Other Special Services OTHER

3,088 28 868 3,984 100 71 111 (59) 341 42 324 3,029 369 910 4,308 33 3 36 20 MENTAL HEALTH AND WELL BEING SUPPORT GROUP SIX MONTH PROGRESS REPORT DECEMBER 2001 – LOTHIAN FINAL 19/12/01 Footnotes:

** Denotes specialist and other services for a population wider than Edinburgh. Notional Expenditure Shown Based on Population. Services cannot be changed unless agreed across all Joint Plans # Additional Activities to be linked to existing services as agreed. 1All changes shown are in accordance with the Joint NHS and Local Authority strategies on Mental Health Services. 2All changes shown are in accordance with the Community Care Plans and Joint Strategies for Mental Health Services. 3Community Supported Accommodation costs are shown net of any DSS income. 4Rehab-Residential amount shows nominal split- Final agreement pending joint LH/MLC discussions. 5All future R.T final agreement pending joint LH/MLC discussions 6Additional MLC spend of £42k in 1999/2000 expenditure category to be confirmed by MLC.

Voluntary Organisations Arts Action 4752 4752 SAMH Midlothian Text 5288 5288 Midlothian briefing 10220 10220 Scheme Midlothian Association for Mental Health 2500 Penumbra 6169 6169 28929 28929

21 MENTAL HEALTH AND WELL BEING SUPPORT GROUP SIX MONTH PROGRESS REPORT DECEMBER 2001 – LOTHIAN FINAL 19/12/01

EDINBURGH: MENTAL HEALTH STRATEGY Designated Mental Health Services purchased by Lothian Health & City of Edinburgh Council Occupied Beds/Places

Mental Health Services Existing Base 00/01 Changes NHS Reprovision/(Net Net Change Forecast Base Existing Forecast Release) NHS RT CEC Total 2000/01 2001 2002/ 2003 NHS RT CEC Total NHS RT CEC Total Base Changes Base /02 03 /04 HOSPITAL SERVICES Royal Edinburgh Hospital

Acute General Psychiatry Inpatients 5,268 (255) (258) (513) (513) 4,755 4,755 145 (20) 125 General Psychiatry Outpatients 177 177 177

Rehabilitation Inpatients 458 458 458 458 15 15

Continuing Care/ Resettlement Inpatients 1,313 (426) (195) (169) (364) (364) 949 949 153 (92) 61 Anti-Psychotic Drugs 360 360 360 360 COMMUNITY SERVICES Community Services (NHS Purchased) Edinburgh Healthcare Community Mental Health Teams 2,654 737 (172) (172) (172) 2,482 2,482 General Psychiatry Day Patients - REH 1,845 1,845 1,845 Western General Hospital Day Hospital 656 656 656 656 Primary Care Services Localities 380 380 380 380 Other Primary Care related services 100 100 100 100 100 Community Services (LA Purchased) Community Support

Voluntary Organisations R.T 467 467 75 75 75 542 542 19 19 Day Services & Activities 506 506 506 506 Supported Accomodation 1,037 1,037 1,037 1,037 M.I.S.G. 1,776 1,776 1,776 1,776 Dept. Residential Units 458 458 458 458

Social Work Teams (incl. MHO/Practice Teachers/Teams) 1,535 1,535 22 MENTAL HEALTH AND WELL BEING SUPPORT GROUP SIX MONTH PROGRESS REPORT DECEMBER 2001 – LOTHIAN FINAL 19/12/01 Respite 75 75 75 75 75 CE Council Other Budget Expenditure

Community Services (NHS/LA Purchased) Community Supported Accommodation 1,019 1019 150 1,169 317 1,019 150 1,485 92 92

EDINVAR - SW (Wester Hailles) 203 (190) 190 13 190 203 13 13 Other Community Based Projects(Day Activities) 70 70 70 130 70 200 Other Community Services. (Edinburgh Healthcare) 30 30 30 Advocacy - (Edinburgh Healthcare) 42 42 42 SPECIALST SERVICES - ** Edinburgh Sick Children Special Services Young People 995 995 995 995 Royal Edinburgh Hospital IPCU 327 327 327 327 Forensic 1,489 1,489 1,489 1,489 Alcohol (Inpatients/Daypatient/Outpatient) 505 505 505 Brain Injury Inpatients 146 146 146 146 Other(Eating 341 341 341 Disorders/Psychology/Psychotherapy/Psychosexual) Young People Services (Inp/Op) 803 803 803 Royal Infirmary of Edinburgh Liaison Psychiatry 185 185 185 185 Western General Hospital Liaison Psychiatry T.B.A 77 77 77 77 Other Special Services OTHER Short Term Costs Patient Advocacy Change Management

18,699 467 5,312 24,478 478 714 (424) (1,139) 1429 150 440 17,560 1,896 5,462 24,918 345 (20) 325 23 MENTAL HEALTH AND WELL BEING SUPPORT GROUP SIX MONTH PROGRESS REPORT DECEMBER 2001 – LOTHIAN FINAL 19/12/01

Footnotes: (see note 4) ** Denotes specialist and other services for a population wider than Edinburgh. Notional Expenditure Shown Based on Population. 1All changes shown are in accordance with the Joint NHS and Local Authority strategies on Mental Health Services. 2All changes shown are in accordance with the Community Care Plans and Joint Strategies for Mental Health Services. 3Community Supported Accommodation costs are shown net of any DSS income. 4CEC growth in spend of £150k - phasing to be advised by CEC.

Voluntary Organisations Penumbra (Greenhill Terrace Tcc) Craigmillar Day Centre 33066 33066 Care in Action (Stafford Centre) Cowgate Day Centre 6540 6540 OASIS 15607 15607 Edinburgh University Settlement - previously in Bridging Finance Edinburgh University Settlement - previously in Bridging Finance Edinburgh University Settlement - Milton Road Gorgie City Farm 154 154 Penumbra (Albert Street) 5160 5160 SAMH Atlantic Text 8391 8391 SAMH Kitchen 18079 18079 SAMH Sprout (Astley Ainslie) SAMH Sprout (Redhall) 25411 25411 Edinburgh University Settlement - Stepping Stones Penumbra (to be allocated) 52971 52971 EAMH 25400 25400 Prop Stress Centre 4746 4746 EDINVAR - Wester Hailes 98/99 inflation 99/00 inflation Bridging Finance Projects North Edinburgh Churches Project Edinburgh University Settlement 467257 467257