Community, Health and Social Care Scrutiny Committee
Wednesday 24 January 2007
Agenda Item: 5
Report on the Consultation on
“The reconfiguration of mental health services for older people –delivering community-base assessment and support, day services and respite care provision”
1 Introduction
Joint proposals for the modernisation of community mental health services for older people and their carers were set out by Salford City Council Community Health and Social Care Directorate, Salford Primary Care Trust and Bolton, Salford and Trafford Mental Health Trust, Salford Mental Health Directorate
in a consultation paper entitled “Consultation on the reconfiguration of mental health services for older people -delivering community based assessment and support; day services and respite care provision.”
The proposals are for one stage of the development of a whole-system of integrated services for older people with mental health needs and a significant part of Salford’s work towards achieving the stated vision of citizens for growing older in the city.
“ The vision of Salford’s citizens is to be able to remain in our own homes, or as close to home as possible as we grow older .In order to achieve this, facilities and services should be developed which are easy to access and which recognise our local communities in Salford. The needs of the most vulnerable must also be taken into account within any plans. We want to take pert in any decisions which are made about how services and facilities should be developed in Salford.”
The model for integrated services is shown in Appendix A. It builds on the recommendations of a report following extensive review and consultation, jointly commissioned by agencies in Salford, on mental health services for older people and their carers. [Lake and Lacey 2005] It also reflects subsequent national best practice guidance such as Everybody’s Business. [D.O.H. 2005]
Key features of the model are:
· A community –based approach –with services /care delivered wherever possible within localities/neighbourhoods and linked with the development of practice –based commissioning
· A stepped -care approach-with services delivered in tiers or levels [as shown in the diagram] to meet varying individual levels of need at any time and linked by clear pathways through all levels so that there are no gaps in services for older people and carers to fall into as needs change.
· All tiers of provision underpinned by robust foundations –user and carer involvement, workforce planning, strong leadership, health promotion, assessment and care planning, culturally appropriate services
This paper summarises the proposals, describes the consultation process and
the responses received to the proposals, addresses the main themes and makes recommendations for taking this vital work forward.
2. Summary of the Proposals
2.1 Background
The consultation paper proposes changes to some health and social care services for older people with mental health needs and their carers.
The changes that are being proposed will affect:
Day Hospital Services at Woodlands and Gloucester House
Day care at White Meadows
Short term breaks and assessments at White Meadows
Mental Health services in the community
Support to carers
The services described in the consultation proposals will form part of the specialist mental health intermediate tier of services, between primary care and hospital care in Salford’s integrated model. They will form a managed network of care to:
· Enhance specialist support to older people, carers and staff from mainstream services
· Facilitate appropriate alternative responses to acute admission
· Provide opportunities for timely, supported discharge.
2.2 Summary of main proposals
2.2.1 Context
As the number of older people with mental health problems is increasing, and more people wish to remain in their own home with support, it is important we modernise services based on the best practice to enable people to have as much independence as possible, retain the skills they have and support them in ways that are individual and meaningful. We need to make sure the buildings people come to for day care or short stays are of good quality and enable people’s care to be delivered by skilled staff, with dignity in a safe environment.
These proposals should be seen alongside the changes in inpatient services, which were also formally consulted on and are now being implemented.
2.2.2 Developments at White Meadows
We would like to develop a Centre of Excellence on the site of White Meadows to bring together a wide range of services for older people with mental health problems and their carers. This would include specialist day services with 20 places for assessment and on-going support, a base for a community mental health team, carers support, an educational / information centre for individuals and their carers, including a demonstration site for assistive technology. There are currently 8 places with an average of 80% usage.
As a result of the changes proposed on the White Meadows site, respite services will be transferred to care homes in the independent sector, supported by older person’s community mental health teams. [c.m.h.ts]
2.2.3 Multi disciplinary Community Mental Health Teams
Community- based services are currently provided by health and social care staff who are not based together and who are therefore not able to deliver a truly integrated multidisciplinary approach to supporting older people with mental health needs.
We would like to create a single point of contact for health and social care professionals working together in two community mental health teams. They will support people in their own homes, offering:
- Advice and education on the management of mental health problems by other professionals;
- Treatment and care for those older people with time-limited disorders [e.g. depression, anxiety], who can benefit from specialist interventions;
- Provide treatment and care for those with more complex and enduring needs; [e.g. dementia, schizophrenia, and bipolar mood disorders]
The reconfiguration of health and social care services into multi disciplinary teams, will provide some increased capacity to support people at home at times of crisis.
The teams will work alongside the memory assessment and treatment service and link to Age Concern support workers.
The areas served by the teams will be coterminous with the two Primary Care Trust localities [East and West], each of which contain four G.P clusters and also with the developing integrated health and social care teams, with one cmht serving the east of the city, based at Meadowbrook and the other the west, based at the Centre of Excellence at the White Meadows site. The cmht. at Meadowbrook will provide mental health liaison with Hope Hospital.
This configuration will enhance opportunities to provide coordinated and responsive services to meet a range of physical and mental health needs now and for the future.
Good quality hospital care remains vital. The community teams will have close links with the inpatient services, enabling swift access to inpatient care when needed, and supporting a return home when the episode of care is completed.
For some people, there will come a time when it is not possible to provide enough support in their own home and a move to residential or nursing care home becomes the best way of meeting their needs .The creation of community teams will enable stronger links with residential homes to support people with mental health problems.
2.2.4 Hospital Day Services
Hospital day services are currently provided on two sites at Gloucester House in the Broughton area of the City [20 places], and at Woodlands in Little Hulton [30 places]. Gloucester House is poorly designed and does not provide a modern, fit- for- purpose service.
Current average attendance at Gloucester House is 10 and at Woodlands 15
It is proposed to close Gloucester House and concentrate provision at Woodlands, with 20 places offering day assessments and treatments for people living in their own homes, including people living in residential and nursing care homes. This will prevent the need for hospital admission, when care is provided at home, supported by the older peoples community mental health teams.
Good practice suggests the need for varying levels of day services and the proposed reconfiguration of day hospital resources, increased specialist day care provision at White Meadows combined with robust pathways which include community-base day services, will give greater flexibility to meet a range of needs
2.2.5 The aim of the service redesign will be to assist in identifying mental health needs early, offering support in the community to prevent crisis, including support to carers. Where more intensive support is needed this should reach into people’s homes and be provided through a range of integrated day services.
The aim of our proposal is to make better use of resources to improve services. This will mean that some people’s care and support is delivered in a different way and in a different place. It will involve working differently with primary care and GPs, hospitals and care homes. It will mean changes for many staff, some of whom may need to develop different skills.
Outline Timescales for the Proposals - see Appendix B
3. The Consultation Process
The purpose of the consultation process is to enable a better understanding of the impact of the proposed changes from different points of view and use the information to help refine the plans. The consultation period was from September –December 2006.
3.1 Methods of Consultation
· A full consultation paper was circulated widely.
[Distribution list Appendix B]
· A summary leaflet was produced by Salford CHSCC with the emphasis on plain English and was circulated widely.
[Distribution list Appendix C]
· The consultation document was supported by offers to attend meetings or discuss the proposals with individuals.
· An audio version of the document was produced on request, with the help of Salford Talking Newspaper and four extra copies made available.
· Both the full and shortened documents were available on Salford City Council’s website.
· Two public consultation meetings were held at Swinton Library, one on the evening of October 9th and one in the afternoon of 23rd. November. Both were advertised in the Salford Advertiser and were also publicised to service users/carers.
· A joint press release was circulated and an article appeared in the Salford Advertiser.
· An article appeared in Salford Carers Newsletter.
· A range of meetings were held with Users, Carers and Staff as groups and individuals.
Respondents had the opportunity to comment on proposals by telephone, letter, e-mail, and in person. Reply forms were available at the public meetings and were distributed by some organisations with the summary.
A central record of the consultation process has been established.
4. Review of the Responses to the Proposals
4.1 Numbers and Format of Responses
It is difficult to give a finite number of responses because of the range of methods of consultation that were used to make commenting easy.
A range of meetings was held with users, staff and carers and notes were made of these and fed into the process. Staff were also available to answer direct queries and concerns from individuals as they arose.
In total 25 written/emailed/telephone responses were received and 16 people attended the public meetings. More detail of the responses is given in the table below:
4.2 Who commented? - Profile of Respondents
Responses:
Description / Number of Responses / Additional Notes/InformationUsers / 2 Attended meetings with carers
Carers / 16 written7 public meeting / Some carers who replied also attended the public meeting
BST staff / 5 written / Including 2 group responses
Salford City Council Staff / 2 / Including a joint response from people with BST staff
GPs / 2
Voluntary Organisations / 2 / Through discussions
Anonymous / 1 / On reply slip
Copies of the original responses are held centrally.
4.3 Overview of the Responses to Consultation.
4.3.1 Through the range of replies, the principle of services working more closely together was welcomed and there was recognition that there were many good experiences of services, and examples of excellent practice that should not be lost, but built on in any new developments.
4.3.2
The need for accessibility, flexibility and responsiveness were keynotes underpinning thoughts about services in general, along with the need for continuity of services throughout any changes.
These features were seen as particularly crucial if meaningful support is to be given to carers, and continuing recognition of their needs in relation to the services being consulted on was seen as a positive way forward.
4.3.2 In relation to day services provision, the main issue was whether there would be sufficient capacity to meet demand, rather than specific concern about the closure of Gloucester House. It was felt that the services should be easily accessible, with equity across the city and appropriate transport was recognised as crucial for this very vulnerable group of older people.
4.3.3 The impact of the changes relating to the reprovision of beds from the White Meadows site stimulated comment from a wide variety of perspectives, including questions of quality and concerns about the about the potential absence of the residential assessment function. Whilst the initial proposal was to reprovide 15 short stay residential beds, in the light of feedback there will be further analysis to determine if this is the best way forward, or if there should be reconsideration of the function of some of the beds to include assessment or Elderly Mental Illness [ EMI ]nursing or residential beds, for example.
4.3.4 Responses to the potential reconfiguration of the beds and changes in day services highlighted the whole question of respite, emphasising how crucial a range of provision is to enable older people with mental health needs to stay at home, with particular significance to carers; contributing to the reduction of stress and maintenance of family life.
Not all issues raised about respite related to the proposals in the consultation document and to address these, a broader workstream has been initiated.
4.3.5 The consultation has in fact flagged up a range of areas of development for future consideration, to enhance provision, including:
The interface between physical health and mental health, links with primary care and practice –based commissioning, the potential role of GPs with a special interest in the mental health of older people, EMI nursing and residential provision generally, seven day service provision, services for people with functional illness, intensive homecare.