Agenda item

To receive a presentation from officers from the local Mental Health Services of the West Essex Clinical Commissioning Group on local mental health issues.

The Committee welcomed Melanie Crass, the interim Head of Mental Health and Learning Disabilities Commissioning for North Essex and Dr Kamal Bishai, the Vice Chairman of the West Essex Clinical Commissioning Group (CCG). Also in attendance was Andrew Smith a governor of the North Essex Partnership of the NHS Foundation Trust who sat in as an observer. Ms Crass and Dr Bishai were there to talk about local mental health services and the Joint Health and Social Care North Essex Mental Health Strategy 2013-17. Ms Crass noted that she was on secondment at present supporting the three Clinical Commissioning Groups and Essex County Council. She was there to talk about the joint Mental Health and Social Care Strategy, a four year strategy that had been developed over the last six moths (see attached presentation). A lot of consultation on this had been undertaken since June 2013. Their vision was that they wanted people to have good mental health and people with mental health problems to recover as well as having a better quality of life. It was noted that they wished to achieve this vision developing and supporting community well-being and encouraging people to maintain healthy lifestyles and keep themselves and their families mentally well.  They would improve access and the gateways into services and would ensure a smooth transition between services, including children to adult services, and have a more integrated approach to the mental and physical health services.  They would develop a broader primary and community based models of care for people across the spectrum of mental health conditions.

The Committee noted that currently 1 in 6 people would experience mental health problems at any one time in their lives. A predicted increase in demand of 2.7% was expected by 2020, also a predicted increase in dementia as a consequence of the increase in elderly persons in North Essex. It was noted that there was a strong relationship between physical health and mental health and that there was an inequity of provision across the three North Essex CCGs. This went back to the days of the Mental Health Partnership Trusts and to the reorganisations and it was also linked to the CCG budgets as they received different amounts. It was also noted that that there was insufficient housing for people with mental health conditions leading to delayed discharges.

Ms Crass noted that North Essex was made up of three CCGs, Mid, West and North East Essex. They spend £110million per annum and Social Care invests just over £12.5 million p.a. They have striven to deliver a comprehensive ‘Improving Access to Psychological Therapies’ (IAPT) and its early intervention programme. They have a ‘Recovery College’ in Mid Essex and community development services. They did a fair amount of joint commissioning with Social Care under a Section 256 agreement with the Essex County. Also, Essex County Council had commissioned a Community Dementia Service investing about £1million. The three CCGs worked closely with individual placements outside of the local provider.   They have a joint initiative with the Probation Service and have a locked rehab facility in Edward House that has had some very good CQC inspections and reports.

Some of their key messages were that there was recognition that suicide prevention was a responsibility for all. There was recognition that there was a need to ensure a holistic approach with true integration of mental health services with physical health provision. There was also a need to transfer low intensity services into the community to develop greater provision in primary care. There was a need to work more closely and collaboratively with voluntary and community services to support local populations.

The Committee were shown a diagram showing access to services and where people could get on and off wherever they may be and have a level of integration and a smooth transition into other areas of service. It was noted that the work was very GP driven.

Proposed ambitions and models of delivery have been developed in conjunction with the North Essex Mental Health Strategy and used a number of documents to help them such as ‘No Health without Mental Health’, ‘Building resilient communities…’, ‘Joint Commissioning panel for Mental Health’ and ‘NHS Confederation: A primary care approach to mental health and well being (2013)’. They were trying to localise the Models of Care from an Essex model, incorporating local ambitions and improving access to services.  They would achieve this by working closely with their public health colleagues and establish a North Essex Mental Health Network and develop a consultant/GP think tank. They were also looking at producing a Personality Disorder Strategy and looking to work with specialised commissioners. They wished to develop an integrated primary/community based care for the delivery of mental health services and the management of long term conditions and to establish improved pathways to reduce A&E attendances. They were looking to improve access to services and reduce waiting times for assessment, diagnosis and treatment. They were also looking at the use of Key Performance Indicators monitoring for their contracts. During the next six months they would review their services. Next year they would do more work on Primary Care and working with GPs.

By the end of year one, they hoped to have:

·         Explored opportunities of joint commissioning with their public health colleagues to support early intervention and community wellbeing;

·         establish a North Essex Mental Health Clinical Network (likely to be locality forums) and get their input into service and pathway redesign;

·         developed a series of ‘Think Tanks’ to explore, across all providers any opportunities for improvement;

·         further developed IAPT, primary and community mental health services;

·         developed the roll out of Primary Care (General Practice) Mental Health Education Programme;

·         development of a single point of access (primary care based); and

·         Development of Personality Disorder Strategy for North Essex.

Finally she outlined some future aspirations for them such as:

·         A further development of primary care mental health including the establishment of a “hub” model; and

·         Implementing a Mental Health Redesign Programme based on the findings of the 2014/15 review, to enable the delivery of the strategy and local plans focusing on early intervention, community well-being and the integration of physical and mental health.

Councillor Angold-Stephens thanked Ms Crass for a comprehensive report. It seemed labour intensive and costly, did she have the resources to achieve it? Ms Crass said that she did, they had developed local strategies and had the infrastructure in place, there was still a long way to go but they have identified key areas of strategy.

Councillor Wixley noted that she had mentioned the community and social clubs and also referred to peer support. He noted that there was a club in Loughton that was very popular but was closed down due to lack of funding; it had been open for 10 years. Was there an opportunity to bring this, or something like this back now? Ms Crass said the finances were constrained and they were facing challenges to try and to redesign support and achieve effectiveness, although Primary care was the way to go. Dr Bishai noted that this had been asked before and he had not been able to get an answer as to why this had closed. They were keen to develop an integrated approach in this locality. One Epping Forest was trying to promote this.

Councillor Knapman said that Ms Crass did not mention resources; it was more of a wish list. Did she have the money to deliver this? Ms Crass replied that they did have financial challenges and were trying to understand more on how they spent their money and how to offer services in a different way. They had not costed their strategy.

Councillor Knapman said if they had no idea how they could deliver their strategy and how could they be sure that Epping Forest was getting is fair share of this ‘cake’. Ms Crass said that Epping Forest was getting its fair share, they had a certain level of data but it needed to be improved. Their services were aspirational.

Councillor Knapman noted that ‘Commissioning’ was the buzz word now, but did they have a de-commissioning strategy to appoint someone better if needed. How easy was it to de-commission a service? Ms Crass noted that they were governed by NHS contract rules, and they would have a 6 or 12 month period that they must adhere to. The CCG have had to decommission services on occasions, but she was not sure of the process.

Councillor Knapman expressed concern about confidentiality and patients records. He had opted out the proposed NHS data sharing scheme as the system seemed flawed. It seemed to him that the records of the people that Ms Crass dealt with were more important to be kept confidential. Ms Crass said that they had adhered to all legislation on data management. Dr Bishai speaking on resources thought that for a long time West Essex had been under resourced and this had now been recognised and would be rectified over the coming years. There was some light at the end of this tunnel.

Councillor Murray thanked Ms Crass for her presentation and said he did not disagree with any of it.  He tended to get his information from ground level as a ward member from his residents and wanted to echo what Councillor Wixley said. ‘Spanners’ was the community based club in Loughton providing help for the mental health community. He found that in Loughton people could only access mental health services when they were over step 3 as shown on her diagram and he would like them to have it earlier. Ms Crass said that at present they had the IAPT services that was there for all and could be delivered on a one to one or a peer group service. Under this a whole range of services could be provided. Dr Bishai noted that GPs were in support of mental health services. Part of the problem is that IAPT cannot find suitable premises to operate from; this was something to be worked on. Councillor Murray said it sounded like things were getting better from a low base.

A member of the public said that he was a user of the mental health services and had been a user of the club in Loughton, which had provided him with a lot of help and support over the years.  Noting that in 1997 there were a lot more mental health services available. In 2010 the ‘Spanners Club’ went and West Essex Mind took over the services and all that they have now was a Tuesday morning service. Mental Health was not a 9 to 5 thing; if you were not well you could not face normal activities also there was nowhere to go at night time. When are we going to have Loughton Services, where we need a 24 hour drop in centre? Ms Crass was aware of West Essex Mind but not this issue; she would take it back for an answer.

Councillor Lea noted that there were not enough attention at the GP and not enough early intervention especially for people with depression and on the verge of suicide. Ms Crass was pleased that there was now recognition of suicide prevention was for all and there will also be prevention training and it will be rolled out to the rest of Essex.

Councillor Janet Whitehouse noted that between the 3 CCG and Essex County Council and the North Essex Trust, who offered what services and if we had any complaints who did we complain to. Ms Crass replied that the 3 CCGs were the responsibilities of the Commissioners along with all health services through Essex, including Mental Health Services.  The Princess Alexandra was your acute provider.

Andrew Smith commented on the point raised earlier by Councillor Knapman on the alleged unfairness to West Essex. There were three Clinical Commissioning Groups across the North Essex patch. Here the CCG is West Essex and the North Essex Partnership University Foundation Trust was the specialist mental health provider. The trust, created in 2001, had inherited existing mental health services along with the distribution of services being based where they were before 2001 although some things were new. Individual CCG’s spend money and provide services in their own patches. Some services would not exist in some areas at all and people from Epping Forest might find themselves put elsewhere and not in their local area as there would be no bed available locally. Distribution was partly a matter of what individual CCGs or PCT choose to spend at the time.

Ms Crass added that there were in-patient services and a range of community services, which comprised the traditional mental health team and the early intervention teams. These were providers across the three localities that linked into particular GP practices.

Councillor Mitchell asked how they would monitor these services and was told that all services would have a NHS contract and would have to meet this level of service.

Councillor Angold-Stephens commented that he had read a report that said that there were 32,000 children in Essex in need of support. He had seen children in schools that had severe behavioural problems. Where was the line between mental health problems and behavioural problems? Ms Crass said she was not responsible for children and adolescent services and could not comment in detail on their services. She recognised that many young people were diagnosed in their teens. 

Councillor Watts asked if Ms Crass could come back in a year’s time to update the committee on the progress made. This was agreed by the committee.

The Chairman thanked Ms Crass and Dr Bishai for their informative and interesting presentation and hoped to see them in a year’s time for an update.