Turning Point – Written Evidence (LBC0192)

Background

Turning Point is a leading social enterprise providing health and social care services across England supporting people to improve their health and wellbeing whether that is at home, within the workplace or through our specialist services. In doing so we build upon 56 years of experience in the fields of substance misuse, mental health, learning disability, autism, acquired brain injury, sexual health, healthy lifestyles and employment support.

Our core business is delivering health and social care services for the public sector. Our mental health, sexual health, substance misuse, learning disability, healthy lifestyles and employment services are commissioned by local authority adult social care and public health teams and by NHS trusts and clinical commissioning groups, NHS England, Public Health England and the Ministry of Justice and the Department for Work and Pensions. Through our commercial ventures, we deliver upstream health and wellbeing services in the workplace. As a social enterprise any surplus is invested back into the business, ensuring that the value created is sustained over the longer term for the benefit of the people we support and for more people in the future.

Are there any positives you would take from this pandemic?

Greater digital delivery of services

The COVID-19 pandemic has meant that the need for safety must also be balanced with the need for people with mental health problems to remain connected to essential services. Within our Improving Access to Psychological Therapies (IAPT) services we have found the shift to video therapies to be a positive lesson learned over this period. Preliminary evaluation on the impact of this new way of working on IAPT clients indicates improved engagement and recovery rates. Feedback from therapists has been generally positive and people have been surprised by how well clients have been able to engage with it. We have found that for both our Luton and Wakefield Talking Therapies Services recovery rates have increased. We partly put this down to engagement rates increasing, as between May and July the DNA and cancellation rates reduced by nearly half. Also in these services between 17-26% accessed our online CCBT offer for the same period.

We have piloted group work using video conferencing technology and increasing the numbers of people getting support via our digital support programme – My Turning Point which includes interactive evidence-based sessions developed by our team of psychologists on a wide range of topics including various substances, anxiety, sleep and low mood. In 2019/20 we had 224 people registered to use My Turning Point. Between April and June over 1,000 people signed up and over 2,500 Find Out More sessions were accessed by service users. A new ‘Reducing your drinking safely’ Find Out More was developed at the end of March and made available to the general public since when it has been accessed over 700 times.

Staff who would normally provide group work and support around employment, training and education have had to develop new ways of working. For example, the Get Connected team at the Drug and Alcohol Welling Service (DAWS) in central London focus their work on the ‘five ways to wellbeing’ (Be Active, Take Notice, Give, Keep Learning, Connect) - a set of evidence based actions to maintain and improve the physical and mental wellbeing of the people they support. Using the five ways to wellbeing as a framework they set up Stay Connected. Each week the team share resources digitally and provide support to enable local residents to set and achieve goals, with suggested activities ranging from enrolling on accredited distance learning courses, developing exercise goals, accessing online mutual aid groups or registering enrolling on the My Turning Point platform.

However support is delivered, it is important that digital & virtual service offers are mindful of the risks of digital exclusion which are particularly pronounced for people with severe mental illness, people from BAME communities & those with lower socio-economic status.

Better Partnership Working – Rough Sleeping

The pandemic has necessitated all providers of substance misuse services across London to work together to help tackle rough sleeping. It is hoped that new cooperation will be maintained after the virus has passed and allow more people to be supported more effectively.

The number of rough sleepers in the capital has more than doubled over the past 10 years. 8,855 people were seen sleeping rough in London in 2018/19. Clearly, the only way to tackle homelessness in the capital is through an integrated, pan-London response. The homeless population is transient, moving between boroughs, many are not from London originally and a high proportion are non-UK nationals who have no recourse to public funds (including lack of access to benefits, and access to housing). This makes providing holistic support even more difficult.

In March 2020, following the direction from central government to local authorities that they should provide emergency temporary accommodation to individuals experiencing rough sleeping under the umbrella policy ‘Everyone In’, over 5000 people were housed in hotel accommodation across London

The prevalence of substance use disorders and associated comorbidity was anticipated to be high in this population and as such the Greater London Authority (GLA), in partnership with Public Health England (PHE) London, approached the drug and alcohol service provider sector and commissioned a bespoke pan-London substance misuse service for rough sleepers. This was launched on April 3rd under the name the Homeless Hotel Drug and Alcohol Support Service (HDAS-London).

The initiative brings together substance misuse treatment providers in London and provides a single point of contact for professionals working in hotels. HDAS- London represents the first-time drug and alcohol services have been provided in a pan-London model, with providers in both the NHS and independent sector coming together to provide a united service.

Engaging in this work across providers has necessitated strong communication. This manifested itself as a fortnightly ‘cross-provider meeting’ attended by the heads of all service providers provided a forum for rapid escalation of any difficulties with local services, largely in terms of services accepting referrals or sharing information about certain individuals. This was coupled with much more joined up working with primary care, and other NHS services to support initiatives such as blood borne virus (BBV) testing in the hotels.

The project was intended to finish on September 3rd but due to its success ongoing funding for the project has been provided until Mid-October. After this a bid will be made for funding from MHCLG to fund the service until 31st March 2021. This will provide clinical leadership, harm reduction advice and additional continuity of care support where needed for those being resettled.

Looking to the future a second phase COVID-19 health action plan covering substance misuse, mental health, BBV and primary care has been co-produced by the NHS with people with lived experience of homelessness and the independent sector and will be overseen by the Homeless Integrated Care System Partnership taking a population health management approach.

This includes an ambition to develop pan-ICS drug and alcohol detoxification beds and residential rehabilitation, hospital step-down beds for high complex care needs and palliative and care home beds. If the plan to bring rough sleepers ‘In for Good’ is going to work there needs to be:

 Access to housing, benefits and healthcare for people with no recourse to public funds who are sleeping rough;  Incentives to share risk and information across local authorities and across the health/housing sectors; and  Integrated, long term funding pan-London to tackle rough sleeping.

What are the things that you are most worried about?

Strains on the nation’s mental health

The pandemic and its impacts have led to great strains on our mental health; this has manifested itself in an unprecedented & well documented increase in calls to anxiety helplines & support services. Substance misuse services have seen a 60% increase in incidents during April – June 2020 against the previous year’s figures. Also within Turning point during April and May 2020 we saw a 39% increase in reports across 3 of their crisis services compared to the same period last year, despite the reduced occupancy (as a result on infection control measures) across all crisis services. In Leicester and Leicestershire there has been significant increase in deaths from suicide since the lock-down. There were 39 deaths during April-June compared to 80 in the whole previous year. Given these impacts and the likely longevity of the virus and we must respond appropriately, namely there must be the continued availability of and investment in crisis support which is a central feature of an effective range of accessible local mental health & wellbeing services.

What we have experienced at Turning Point has been supported but further research by the NHS Confederation which suggests that the impact of COVID-19 on the mental wellbeing of staff has been substantial. Mental health services have not yet seen the peak of demand and there are serious concerns over staff burnout, particularly among BME staff that are at greater risk. They have found that without additional staff, the mental health workforce will be at even greater risk of burnout and employee turnover.

They suggest that in the next phase of COVID-19 they expect there to be a number of drivers of additional demand:

 Demand from people who would have been referred to services had the pandemic not struck  People requiring more support due to a deterioration of their mental health during the pandemic  New demand driven by people needing support due to the wider impacts of the pandemic, such as self-isolation and increases in substance abuse and domestic violence.

There are also particular concerns that the stark inequalities in accessing services that black and minority ethnic (BME) communities face will be exacerbated.

Use of DNACPRs on people with learning disabilities

A worrying trend emerged within the health and social care system at the peak of the pandemic; people with learning disabilities and autism were having Do Not Attempt Cardio-Pulmonary Resuscitation or Do Not Resuscitate instructions unlawfully written into their patient records.

If a person has capacity to make a decision about CPR themselves, they should be consulted about such an instruction being placed on their records. If the person lacks capacity to decide for themselves about CPR, then the doctor making the decision on their behalf must follow the procedures set out in section 4 of the Mental Capacity Act. This includes consulting the person themselves, anyone caring for them, and anyone else interested in their welfare, including family. The purpose being to determine what the person’s wishes, feelings, values and preferences would be if they could decide for themselves.

We saw DNR orders that have not been discussed with the person themselves, the staff who support and care for them, or their families. This is very concerning as it may potentially lead to people being denied life-saving treatment that other patients would be granted. National medical director Professor Stephen Powis has said that learning disabilities should never be a reason for issuing an order not to attempt CPR.

This is a human rights issue. Even during such testing times as we are in now, these freedoms are sacrosanct and protected by the Human Rights Act (1998), Equality Act (2010) and United Nations Convention on the Rights of Persons with Disabilities (2006). Existing health conditions or impairments, that are unrelated to an individual’s chance of benefitting from treatment, must not play any part in decision-making regarding equal right to access such care

To try and help halt this practice, Turning Point supported letters issued by National Voices and Disability Rights UK which call for changes to be made regarding how these decisions are made. The recommendations include that the value society puts on lives must not influence decisions to treat.

Another key demand is that existing health conditions or impairments, that are unrelated to an individual’s chance of benefitting from treatment, must not play any part in decision-making regarding equal right to access such care.

As we have progressed from the peak of the first wave of the pandemic these DNACPRs have subsided, however we cannot ignore what occurred and what could happen again. It is extremely troubling that at the onset of a crisis that this was how people with learning disabilities were treated, it speaks to underlying discrimination of these people which still exists. We must ensure that when future crises occur and action must be taken to protect life that the most vulnerable are protected.

What do you most hope changes for the better?

Continuation of volunteering efforts

The unprecedented changes to our people’s lives caused by COVID-19 led to a rise in people committing to volunteer their time to help others. The NHS volunteering scheme had at least 1 million people sign up, with countless more engaging in informal local mutual aid groups. Within Turning Point we have seen much of this positive spirit and commitment to helping others

Since the nationwide lockdown began Turning Point staff have been exceptional in volunteering their time to support our 24/7 services in learning disability and mental health. This was done to alleviate the difficulty and disruption brought on by the COVID- 19 pandemic and ensure we fulfil our priority to maintain service delivery for as many of the people we support.

Since the request began, we received lots of interest from across the organisation, and have worked hard to get people helping out in a service local to them.

Case Study

“As soon as the opportunity arose I volunteered. Coming from substance misuse, I had some prior experience working in mental health but this wouldn't have mattered – a preliminary phone call with the service manager was very assuring, and told me everything I needed to know.

The staff were welcoming and respectful, and from the off I felt a part of the team. One member of staff I partnered with was particularly knowledgeable and professional; in no time at all I felt as though I'd known her for years.

I spoke with every one of the people we support – lovingly referred to as 'the guests', which made sense given the service felt at times like it was a nice hotel! Due to the current restrictions, our activities were sadly limited. So we chatted, watched films and spent time in the garden – and drank a lot of tea!

To anybody thinking of volunteering, I'd urge you to just do it. You won't be expected to do anything beyond your remit – just to muck in and be there to offer support. I'd do it again, no question.”

28 August 2020