Wandsworth CCG Board Meeting – 9 July 2014
Agenda Item 6.1 Mental Health
The report on the year’s work and the immediate programme ahead is a clear and pretty comprehensive one on which the CCG and the Mental Health CRG deserve to be congratulated. It is however quite long and technical – is there any chance the CCG could be encouraged to produce a summary for the general public? We suggest that CCG produces a report of its work on mental health, as a piece of mental health promotion, with a strong focus on raising mental health awareness and thereby helping to reduce stigma.
Demographics and background (including finance)
Under detail of sector of spend is an item that probably needs more explanation:
Independent Sector MH Placements £5,200,000 - is this purely for out of borough placements or for highly specialised treatments? Are there plans to reduce this spending?
Performance and Quality
This focuses on SWLStG, the main provider. It may be worth asking whether quality of other providers’ services is also being monitored.
The main area of underperformance identified is the proportion of people getting psychological therapy (from IAPT). This is an important area of focus for improvement both by the commissioners and the providers which deserves underlining.
The list of performance measures presented is described as a “sample”. One not mentioned which is of some concern to Healthwatch is the continuing relatively low level of identification of carers in the Wandsworth Directorate of the Trust - although we know that efforts are being made to improve this.
Generally we share the prevailing view, confirmed by the recent CQC inspection, that SWLStG under their renewed management team are genuinely committed to quality improvement, although the process of achieving this consistently at all operational levels is inevitably a long-term one.
Service delivery improvements over the last 12 months
The CCG and the CRG deserve to be congratulated on their efforts to secure specific service improvements as a condition of their support for SWLStG’s FT application. Healthwatch have been glad to see the improvement of service user and carer experience specifically included in this list.
The further set of improvement targets for 2014-5 is also welcome, including as it apparently does a (coded) reference to the improvement of arrangements for social care (including Personal Budgets) under the Section 75 agreement between SWLStG and the Council (but see related point below).
Patient and carer experience, the Triangle of Care and carers issues. Also section 5, CRG work programme, p9. Martin has pointed out that Wandsworth has a poor record in identifying carers – well below neighbouring boroughs, where the MH Trust and carers support services seem to work more closely together. It would be worth finding out if there are any lessons we could learn from them (particularly Sutton and Richmond carers’ services).
Expand access to the Recovery College. At the CRG, service users and CFFs asked that access should be extended for up to 2 years after discharge from CMHTs. We also asked for similar access, for up to 2 years, to the MH Trust’s welfare benefits advice service. We think this is very important to help people maintain their recovery and rebuild their lives.
Work programme, BME representation in secondary care. I think we should draw attention to this as an excellent example of the CCG working co-productively with the voluntary sector and service users.
QIPP and CIP
Although included under service delivery improvements these are more about cost-cutting that quality. It is perhaps worth picking up the fact that SWLStG’s proposals for CMHT transformation were “not considered to be clinically safe in relation to local need”. As a result extra savings had to be found including the loss of Wandsworth’s (small) inpatient arts therapy service. This situation is clearly regrettable even if the CCG took the right decision in the circumstances.
Loss of arts therapy services. Clearly this is regrettable but I think it is inevitable given the need for savings. I am very keen that the CCG and Trust retains OT services (which overlap to some extent with arts therapies, and I think are probably more useful). I think we should keep an eye on this. I will also be asking what the NICE-compliant services replacing arts therapy actually are.
Investment in Adult MH Services
The 4 projects listed all seem very worthy of the CCG’s support. It is worth noting that the “recovery rate” achieved in (online) live therapy sessions on the Big White Wall is apparently superior to that of the mainstream IAPT.
IAPT for people with long term conditions
This relatively small extension of the IAPT service is welcome (but rather too much seems to be made of it here).
CRG work programme: The CCG/MHCRG has undertaken a thorough review of psychological therapies, and is taking a strong line with the MH Trust to reduce waiting times and provide a more effective structure of services. This is work in progress and we are confident that this will result in improvements.
IAPT for long term conditions. We are pleased that this important area is being addressed. I think the list of “long term conditions” should include people within primary care with SMI, as well as people with physical health conditions, and it should also highlight giving access to IAPT for carers across all care groups. (See also the analysis on p 13-14 Appendix A.)
MH CRG work programme and priorities
This CRG which has a much wider scope and probably a more significant role than other CRGs is clearly a success, as the breadth and depth of its work programme shows.
Healthwatch welcome the action recently taken, partly at our request, to put the minutes of the CRG online. We see this as a big step forward in the transparency of the commissioning process.
It might be worth pointing out that the CRG (as its published minutes indicate) have also taken an active interest in the issue of social care and Personal Budgets for people with mental health needs, although this is not highlighted in the report. This should be seen as an integral aspect of mental health care and is subject to the joint commissioning arrangements.
Subject to the inclusion of continuing work o social care, Healthwatch can support the DRG’s view of its priorities.
Work programme, BME representation in secondary care. I think we should draw attention to this as an excellent example of the CCG working co-productively with the voluntary sector and service users.
SWLStG’s Foundation Trust application
Healthwatch shares the CCG’s qualified support for the FT application (and made this clear in our submission to the CQC before the recent inspection).
Appendices & Background Information
GP severe mental illness and SMI registers. Issues of concern for service users and CFFs, with increasing numbers of people being discharged from CMHTs. Comes up frequently at service user and carer groups and at the CRG and remains an ongoing – inadequately resolved – issue. Clearly two key aspects to be addressed are
Under diagnosis – mh awareness and GPs’ role as “gatekeepers” for referral to mental health services
Quality of primary care and enhanced care for people with SMI – including physical health needs of people with psychosis (which is not mentioned in this document).
Carers Family & Friends (CFF) and the CCG
We suggest that there should be an additional CRG Priority (page 7).
Most carers and family members are thoughtful and articulate. Our direct concerns and priorities focus on serious mental illness, particularly psychoses, and issues for people who use services (including those who do not have an identified carer or family), carers family and friends. These concerns include inpatient services and, increasingly, the interface between primary care services and secondary specialist mental health services.
There are lots of different types of mental health problem and lots of different types of carer, family and friend. They don’t like being lumped together as “the carer”. Nor do they like being designated as “seldom heard” because they think carers’ voices (plural) and recognition of their issues should be integral to health and social care. We are seeing significant changes, led by SWLStG mental health trust, in this respect but we still have a long way to go.
CFFs are interested in mental health issues across the spectrum. They are concerned about stigma, discrimination, better information and mental health promotion.
They are pleased that the CCG and the MHCRG are giving reasonable priority to CFF issues, though, depressingly, there are still far too many occasions when they have to be reminded that carers exist.
We believe carers’ views are respected on the CRG, listened to and acted upon. All three lead GPs have met with CFFs over the past eighteen months. Jeremy Walsh, Mark Robertson and other MH professionals have visited carers’ support and information groups. Some 60 people, among them CFFs attended a consultation event on the Joint Commissioning Strategy for mental health back in January.
Healthwatch Wandsworth brokered a productive meeting with the Mental Health Trust and carers (5 CFFs and Carers’ Worker) in March 2014, and hopes to arrange a follow-up meeting.
Healthwatch members’ views collated by Jamie Gillespie
7/7/14