Agenda item

The Director of Strategy, AWP, spoke to the report (in the published pack).

The following points were made during the ensuing discussion:

·       Area placements were a significant focus; there were a number of work programmes with the aim of provision of a more sustainable service.

·       Deputy Mayor (Communities, Public Health, Public Transport, Libraries, Park, Events and Equalities) raised concern about issues with communication; that people were not able to navigate the system due to lack of communication.

·       The Committee was advised that the issues surrounding communication were taken on board; it was acknowledged that more needed to be done to find a way to deal with this.   It was agreed that a coherent pathway that showed people what services were available, what they looked like, and what to expect, was needed.

·       Whilst performance had been good there were situations where people were unable to access services due to communication problems.

·       Members stated that the performance in the report did not reflect some constituents’ experiences.  Members were advised that whilst the Key Performance Indicators were good and showed some improvement it was acknowledged that there were experiences of waiting times which needed addressing; some could be addressed with existing resources, but this was limited.

·       The Committee was advised that due to system pressures there was not the capacity to deal with those that did not engage or had disengaged – this was an indicator of pressure on the system.

·       The issues were not due to workforce churn, but due to capacity - more referrals than workforce. 

·       There was a very low bed base compared to the rest of the UK; there was a need to improve recovery capacity.  Rising caseloads had impacted the Intervention and Recovery teams.  It had been identified that not all referrals had needed to be made.

·       It was very important to work in partnership to utilise other sector preventative work which would free up capacity for people in need of care.  Working in Multi-disciplinary teams was a positive way of providing people with more opportunities; a way of working that has not been implemented thus far.  

·       Delayed Transfer of Care was an issue for people with acute mental health conditions.  Reasons for DToC included waiting for housing, including supported and specialist housing; key groups being stepped up into secure pathway – there was need nationally for those placements  (MoJ involvement). 

·       If someone had a specific need the supported housing staff may require specialist training and so this would take more time.  There was little provision outside acute mental health.

·       The Committee was advised that there were good close relationships and links to social care; housing was coming on board with a better relationship with AWP now. 

·       It was very positive that the staff retention rate had improved.

·       There had been workshops with GPs to instil confidence regarding prescribing; GPs were under pressure and so there was a need to ensure they were aware that specialist support was available if needed and that it was accessible.   Relationships with GPs had improved.  There had been plans for future programmes for newly qualified GPs to acquire mental health specialisms.

·       Shared care protocol had been important to enable people to live independently in their communities.

·       Out of area placements was a national issue. There had been a struggle to get beds in the country. 

·       People have needed to be placed a distance away from their homes which was not good for their treatment pathways, and so the strategy had been to get them back as soon as possible.  This was not just about beds, but the whole system, including what happened in the lead up to needing a bed in the first place.

·       Beds were not the whole story – early interventions and care could prevent a need for beds.  There was a need for community solutions so as to lower the need for hospital stays. Resource pressures meant there was a need to come up with creative and flexible solutions. 

·       There was evidence to show that when a Trust concentrated on community mental health, need for bed numbers went down.

·       The Committee was advised that a completed single mental health strategy was due in June 2020.  There was a need to ensure it represented views of communities and other stakeholders.  There was a need for a joint vision – THRIVE was part of that. 

·       The production of the strategy required a robust evidence based to inform it, which included an understanding of need in different parts of the city.  There would be a focus on well-being to crisis.

·       The Director of Public Health told the Committee that the Council was part of an editorial team commenting on the strategy; and that it had been to the Health & Wellbeing Board for comment.   The next version would go to the Health & Wellbeing Board again before Cabinet and partner organisations decision making bodies.

·       There was a lot of ownership of the strategy; with all partners invested in it.

·       The Cabinet Member for Adult Social Care raised an issue of how jobs could be more joined up – voluntary community work and formal mental health employment; which would increase pathways into mental health work more generally. 

·       The Committee was advised that despite increase in retention there was still an issue of workforce shortages including psychiatrists.  There were plans to increase pathways to enter mental health work, which included apprenticeships.  

·       Director of Public Health stated that this issue links with BAME mental health groups; there was a need to reach communities which would help to build workforce.  There were good links which could be built on. 

·       AWP have had 2 people on the Stepping Up programme.

·       There was a discussion about the gap between primary and secondary care.  The Committee was advised that there was a group in the middle where there was a gap of service provision. AWP was commissioned to provide high need service provision; there was work starting to bridge the gap.

·       There was ongoing work with partners to implement a system that worked with Sirona as they embedded community models – which was a system response.