Meeting Details

The minutes of the meeting of the Health Overview and Scrutiny Committee held on 12 July 2017 were approved as a correct record and signed by the Chairman.

The Committee received report HOSC/24/17 and the Chairman welcomed Clare Hardy, Head of Commissioning, Essex County Council, Jessica Thorn, Assistant Director, CAMHS Commissioning, West Essex CCG, and Gill Burns, Deputy Integrated Care Director, NELFT.

Members noted that the Children's Mental Health Services had undergone a transformation over the past two years.  Starting in autumn 2015, seven CCGs and three local authorities in Essex, led by West Essex CCG had integrated their services.  Their first year involved much transition and staff repositioning; their second year, from November 2016, has seen the new practices bedding down, with improvements seen in KPIs, in spite of increased demand.

Members received a PowerPoint presentation on the service transformation, which had been circulated before the meeting; some specific aspects were noted:

• the merging of Tiers 2 & 3 (targeted support and community mental health) and the possible integration of Tier 4 (specialised support) in the future
• an overall integration of the elements of the service, and a more flexible approach, including digital innovation
• greater engagement with schools
• moving away from measuring in terms of simple KPIs toward outcomes.

The size and scale of the transfer was significant and challenges remained in several areas.  There had been a large cultural shift - moving from a clinical to a more outreach and community based approach. And expectations had to be managed over the expected 5-year period of transformation.

The new arrangements brought together the staff from three separate providers into one unit of 180 individuals, in November 2015; and it had taken 18 months to bring them together into a team.  In November 2015 there were 3,000 cases; by March 2016, this number had risen to 7,000, with the same staff levels. This indicated that there had been a substantial number of people untouched by the previous arrangements. 

The NELFT model is based on a single point of entry for the whole of the County, with triage followed by allocation to one of the seven locality teams (ie the CCGs), and then onto an appropriate care pathway. The referral criteria benefit from a much broader brush approach than before - but one troublesome area is that there is no standard pathway for children with ASD and ADHD. It was suggested that a ‘whole approach’ would be more beneficial.

The number of referrals is high - over 13,000 between April 2016 and June 2017; an unexpected shift is that many families see the combination of NHS and social services as providing the treatment for any domestic issues they may have.

There have been 3 recruitment campaigns and the current vacancy level is at 23-27%, which is quite low compared to NHS rates.

Considerable efforts have been directed to targeting teenagers with high use of social media and to providing award-winning digital support. 

With specific reference to the nine recommendations set out in the scrutiny report on ‘Mental Health Services for Children and Young People in Essex’, a copy of the formal response to each recommendations is attached at the Appendix to these Minutes. 

Members received responses to issues they raised, including reference to the recommendations listed in the meeting papers:

• the task has been a greater one than anticipated, but the work is progressing well.  Main priorities over the next few years are the schools involvement and digital development, with the quality improvement agenda most important.  Underlying this are the countywide approach and application; there is one front door, one one provider and one team - this is a very positive step forward
• a much more open approach is now the norm, with staff working in locations such as family centres and GPs surgeries
• there has been a marked increase in pressure on young people through social media; and many of the problems relate to systemic family issues
• it is hard to judge the actual extent of the problem: the historical figures suggest 30,000 children in Essex with mental health issues; but another study has put it at 60,000, and the Childline research estimates it at 90,000
• the need to work within the existing financial envelope means that it was unlikely that the waiting time of 18 weeks would reduce over the next year or so; but substantial numbers were seen within 6-12 weeks
• Essex tries to work with organisations in the voluntary sector wherever possible, which also have their capacity problems; and the intention is to refresh the relationship with them
• a lot of work has been done to raise the profile of mental health issues, including the publication of Let's talk about mental health, and this will continue to be explored
• a countywide perinatal service should be launched within the next few months
• there are several threads of work toward increasing the workforce, both on a national and County level
• there are also several workstreams in place to improve awareness and skills in schools.  

The Chairman thanked the Service’s representatives for reporting on the progress being made and suggested the Committee be provided with another update in six months' time. She also agreed that it would be useful for Members to be presented with some vignettes of anonymised cases, to provide a clearer picture of the work of the service.

Cllr Sargeant left the meeting at this point.

The Committee received report HOSC/25/17 and the Chairman welcomed Dr Milland Karale, Medical Director for Essex Partnership University NHS Foundation Trust (EPUT), and Andy Brogan, Executive Director of Mental Health, EPUT.

Member noted the progress being made on the progress of proposals for a new clinical model for local mental health model services, and pre-consultation including the following points:

• the two Essex mental health trusts merged earlier in the year, primarily with the aim of improving services
• the basis was the five year view published by NHS England in February 2016 - although it will take longer than 5 years to fully implement; this also informs the strategic needs of Essex, Southend and Thurrock
• two particular areas needing to be addressed are 1, that providers are not responsive and did not act quickly enough, and 2, that the service provided was not appropriate to the 21st century
• two reactions to this are that 1, more should be don at the primary care level, using the patient knowledge and facilities of GPs for instance, and 2, responses should be made at a more localised level (a problem here being that each area has its own way of operating).

Consequently, several workstreams are in place, in the following services (as set out in the paper):

• reconfigure community mental health services to "wrap around " primary care
• re-model the services to in line wth the national pathway for people with dementia
• transform how services are provided for people with personality disorders
• improve emergency and in-patient care services
• extend perinatal services.

The commissioning environment is a complicated, with separate providers in the north and south of the County plus Southend and Thurrock.

The past year has seen a 19% increase in presentations in mental health, which has not been matched by staff increases.  The Government's Mental Health Workplace Plan aims to find 21,000 extra full-time staff to work in mental health - of which Essex would expect about 500.  The EPUT vacancy rate is 14%, about the national average.

Members received the following information in response to their questions and points raised:

• each area has its own way of working but there is an overall strategy; and there has been a change in attitude, toward partnership working.  This stretches beyond the purely medical, as mental health issues impact on both physical and social elements of an individual's life.  Some approaches are practical, eg asking individuals onto certain bodies to assist develop models; and the trust has been working with the three local authorities
• several initiatives are in place to make sure that patients do not stay in hospital longer than they need to, eg in early planning, to  ensure that appropriate housing, etc would be in place.  Although there are a number of delayed discharges at any time, it is a much smaller problem than in the acute sector
• Regarding consultation, the trust wants to be as open as possible as it moves forward and will take a view on each course of action, to assess the level of consultation it requires
• recreational drug and alcohol abuse constitute major issues for the trust, in some cases are major precipitants for mental illness
• at present, beds in the north are always full, but not so in the south.  The creation of an assessment unit in the north would be a great benefit, as it would have a consultant doing rounds seven days a week; as opposed to another unit, which would not benefit from this at weekends. 

There being no further questions, the Chairman thanked Mr Brogan and Dr Karale for their contribution.  She asked that they return to the Committee in about six months' time to provide an update on progress.

The Committee noted that the next activity day would take place at 9.30am on Wednesday 11 October 2017, in Committee Room 1, County Hall.

The focus of the next meeting would be the Strategic and Transformation Partnerships (STP).  A public notice on the Mid and South Essex STP ‘Our Future NHS – update on current progress towards consultation’ had been circulated to the Committee beforehand, and the Chairman confirmed that its consultation proposals would feature in the October agenda.

There being no further business the meeting closed at 3.37pm.